Apprenticeships
	 — 
	Question

Lord Horam: To ask Her Majesty’s Government what is the current number of people starting apprenticeships each year; how that compares with 2009–10; and what measures are being taken to improve the quality and number of apprenticeship schemes.

Lord Ahmad of Wimbledon: My Lords, in 2012-13, there were more than 510,200 apprenticeship starts, which is up by 82.4% on 2009-10. Also, 1.5 million new apprenticeships have been created since the Government came to power. Our reforms will ensure that apprenticeships are even more rigorous and responsive to the needs of employers. Putting employers in the driving seat will create apprenticeships that are able to meet employers’ needs.

Lord Horam: My Lords, historically, and to our cost, Britain has not been good on technical education. Therefore, the information that my noble friend has just given on the number of apprenticeships represents a real success story and a real breakthrough. It is also good that we are involving employers in the design of schemes. Will my noble friend ensure that small and medium sized companies get a good look in as well as bigger corporations as I know from personal experience that they have a lot to offer in this area?

Lord Ahmad of Wimbledon: I agree with my noble friend. Apprenticeship is a real success story of our country and we should all encourage it as best we can. We have announced eight trailblazer projects, which will be the first to develop new standards and approaches to assessment for apprenticeships. These began work in autumn 2013. My noble friend raised the important issue of small businesses. Almost 50% of our apprenticeships are in small businesses but there is only a 13% take up. Therefore I am delighted that the apprenticeship grant, which we have also launched, will allow new employers with fewer than 1,000 employees to take on new apprentices aged between 16 and 24, which the Government will be supporting fully.

Lord Brooke of Alverthorpe: My Lords, is the noble Lord aware that recent research indicates that among 14 to 16 year-old youngsters at school only one in five knows of the existence of apprenticeships? He will, however, be aware of the recent Ofsted report which criticises the Government for their failure to provide proper career guidance. What do the Government intend to do in response to the Ofsted criticism?

Lord Ahmad of Wimbledon: It is important to ensure that in our schools and universities, through the careers advice services, students are made aware of all opportunities at all levels. We are working closely with the Department for Education to ensure that that happens. Small businesses are also working closely at a local level and the Government strongly encourage that partnership working.

Lord Aberdare: My Lords, does the Minister agree that existing apprentices are one of the best resources for promoting awareness and take-up of apprenticeships? What steps can he take to encourage initiatives to take advantage of this potential, such as the Industry Apprentice Council set up by EAL to give a mouthpiece and forum for apprentices in the engineering sector?

Lord Ahmad of Wimbledon: The noble Lord has raised an important point. In any field, what better role model can there be than a mentor who has actually been through it themselves? Mentors are engaged through initiatives from the National Apprenticeship Service, while the trailblazer projects work at the local level through local partnerships up and down the country, including in Yorkshire, the north-east, London and the south-east. We will be encouraging mentoring as a key part of those initiatives.

Lord Storey: My Lords, the Minister will be aware that many schools have a vested financial interest in keeping young people at school often to follow courses that do not fulfil their needs. How can those young people receive independent and impartial advice which might include the option of an apprenticeship?

Lord Ahmad of Wimbledon: It is important that schools look at their focus in terms of career guidance and we are encouraging that through the Department for Education. Changes have also been made to higher apprenticeships which now provide a clear work-based progression pathway into higher education and professional careers. We want to ensure that apprenticeships are held in the same high regard as degrees and we believe that schools are going to be key in ensuring the promotion of apprenticeships.

Lord Martin of Springburn: My Lords, I congratulate the Government on the good work they are doing on apprenticeships. Will they consider the fact that many young men and women over the age of 21, who perhaps have lost out because of unemployment, would also appreciate what is known as an adult apprenticeship?

Lord Ahmad of Wimbledon: The Government are fully aware of that fact and I take it on board. Of course we want to encourage apprenticeships across the board and age should be no barrier.

Lord Young of Norwood Green: My Lords, I welcome the Government’s focus on the value of apprenticeships, building on the work of the previous Government. Does the Minister agree that, especially in the 16 to 18 group, demand vastly exceeds supply? To keep on quoting the figure of 510,000 when the large majority of those are adult apprenticeships does not address that particular problem. We have almost
	1 million NEETs and that is the area the Government need to focus on. We still have only a small number of employers taking up apprenticeships. The figure is somewhere between 4% and 18%, and only a third of the FTSE 100. What additional action are the Government taking to resolve a problem that could leave us with a lost generation of young people?

Lord Ahmad of Wimbledon: On the contrary, I would say to the noble Lord that we are tackling the problem head on. We talked earlier about mentoring. The noble Lord is very good role model for apprenticeships and how much one can achieve. I pay tribute to his personal example. On what the Government are doing right now, on 28 October we published our plans for reform in The Future of Apprenticeships in Englandand those reforms will do exactly what is required by increasing the quality of apprenticeships. This is not a numbers game. It is about setting higher expectations with a focus on English and maths. Equally, we are putting employers in the driving seat, making sure that rigorous training is delivered and thus ensuring economic growth. Finally, we are simplifying apprenticeships by replacing long and complex frameworks with a simpler procedure to increase take-up, particularly by small businesses.

Baroness Neville-Rolfe: My Lords, when dealing with apprentices as an employer a few years ago the biggest problem that we faced was bureaucracy. There were bureaucratic requirements for extensive record-keeping that we at Tesco could just about manage, but for smaller companies it is obviously a big issue. Is the system now less bureaucratic? Will the Minister comment on that very important point?

Lord Ahmad of Wimbledon: My noble friend has raised an important point which the Government acknowledge and the consultation proved that apprenticeships needed to be simplified. I go back to my last point by saying that we have done that by replacing long and complex frameworks with one-page standards written for employers to encourage take-up in the SME sector. Equally, we are providing additional grants in the small business sector for organisations with fewer than 1,000 employees. My noble friend talked about the experience at Tesco. I think that large employers have a key role to play in this and Tesco is one example among others of companies that are doing very well. Rolls-Royce in Derby provides 100 to 200 apprenticeships a year and that goes across the board. Large employers and the SME sector both need to be encouraged. Apprenticeship is a success story and we should all get behind it.

Homeless People
	 — 
	Question

Lord Spicer: To ask Her Majesty’s Government what estimate they have made of the spare capacity in London of hostel places for the homeless.

Baroness Stowell of Beeston: My Lords, London has good hostel provision to meet the current needs of the homeless, and a range of services is provided to help rough sleepers off the streets. We are continuing to improve the quality of hostels, with investment nationally of £42.5 million under the homelessness change programme.

Lord Spicer: Bearing in mind what my noble friend has just said, why is the number of people sleeping rough on the streets of London likely to rise this year to record levels at Christmas? If one of the reasons is that many of them do not want to accept the accommodation being provided, why is that the case and what are we going to do about it? I raise this as a former Minister for Housing who, some 25 years ago, started, rightly or wrongly, the grants for rough sleepers. Nearly 50 years ago, almost to the day, I was one of those who set up Crisis at Christmas—now called Crisis—which all goes to show that 50 years can be a short time in politics.

Baroness Stowell of Beeston: My Lords, I pay tribute to my noble friend for his long-standing interest in, and efforts to combat, rough sleeping. I think that I can be quite confident in saying to your Lordships that none of us wants anyone to end up on the streets. Our first priority in government is prevention, and we have invested £470 million on measures to prevent people ending up on the streets. However, in the sad event that prevention does not work, we need to ensure that those who do end up on the street are supported and moved off them as quickly as possible. That is what we are doing. We have provided £34 million to the GLA, which is using some of that money to fund the No Second Night Out campaign. I am pleased to report to noble Lords that 75% of first-time rough sleepers last year did not spend another night on the streets. Rough sleeping is increasing but we are getting people off the streets more quickly.

Lord Rooker: As another former Minister for Housing, I remind the Minister that, by 2005, the previous Government had virtually eliminated the problem of children and families living in hostel accommodation. The situation has deteriorated since then. I am not casting any blame but I have a suggestion. I know that the lady I am about to mention is incredibly busy but, when the Minister goes back to the department, could she commission Louise Casey—who set up the original system in the early part of the previous decade that brought about that result in 2005—to take a few minutes off from dealing with troubled families to have a look at what has gone wrong and why we have ended up with children back in hostels? It is quite unacceptable and totally unnecessary.

Baroness Stowell of Beeston: I am interested in what the noble Lord says, but the information that I have contradicts some of the points that he makes. The most recent statistics that we have show that the number of local authorities accepting families as homeless is
	going down. There has also been a drop in the number of families in bed and breakfast accommodation for more than six weeks, which the noble Lord will know is the statutory limit for any family to stay in a B&B. Overall, because of the money that we are investing in prevention, which I spoke about earlier, the time that families spend in temporary accommodation has reduced from 20 months at the start of 2010 to 13 months now.

Lord Roberts of Llandudno: My Lords, I thank the Minister for her contribution. However, is it not true that one-third of local authorities are not meeting that six-week regulation? I am sure that I speak on behalf of the whole House when I say how much we appreciate the work being done by the various charities and local organisations, especially at this time of year. Churches and so on are doing remarkable work. What are the Government doing to make funding available for the continuation of that facility, to make sure that those who are on the streets have somewhere, especially in the coldest weather, where they can at least have shelter?

Baroness Stowell of Beeston: My noble friend is right to pay tribute to the charities that work so hard to support people who are homeless and find themselves on the street. With regard to local authorities that have not been meeting the statutory requirement to limit families’ stays in bed and breakfasts to six weeks, I responded to some specific questions on this the last time this topic was discussed at Questions in your Lordships’ House. I mentioned then the money that we had provided to improve the performance of those councils, and we have seen some improvement in that area.

Baroness Liddell of Coatdyke: My Lords, is the Minister aware that a significant proportion of the homeless in London are former members of the Armed Forces? It is a scandal that reflects on all of us that these men and women are prepared to go and fight for Her Majesty’s country, but we are not prepared to look after them when they come home. Is it not time for the Ministry of Defence to address this issue and try to get to the roots of it?

Baroness Stowell of Beeston: The noble Baroness is right to express real concern and disappointment that, in a small number of cases, people who have served this country find themselves homeless. The services that are there to support people who are out on the street are working hard for anybody who is out there on the street, including those who are former armed services personnel. We need to ensure that when people are supported, their reason for being homeless is addressed—and that is something that we are focusing on.

Lord Dykes: I thank my noble friend for supporting the No Second Night Out campaign, and wish it success. Will she ensure that the borough authorities, the charities and the GLA ensure vigilance and organisation in the last few days up to Christmas Day, when there may be people left on the streets through inadvertence or a lack of organisation because of the holiday period?

Baroness Stowell of Beeston: Yes, of course. I will also highlight for the benefit of noble Lords another initiative that we have, StreetLink, which is a system that is available for the public to use—I can provide noble Lords with the telephone number and the website address—where people can notify a local authority when they see somebody rough sleeping so that the local authority can go out and offer that person assistance.

Housing: Underoccupancy Charge
	 — 
	Question

Baroness Hollis of Heigham: To ask Her Majesty’s Government how they will achieve the predicted savings from the underoccupancy charge if affected tenants move into the private rented sector.

Baroness Hollis of Heigham: My Lords, in asking the Question standing in my name on the Order Paper, I declare an interest as chair of a housing association.

Lord Freud: My Lords, moving into the private rented sector is one of a number of options available to people affected by the removal of the spare room subsidy. The published impact assessment considered tenant responses, including moves. Savings from the policy are expected to be around £500 million a year. There is currently no reason to amend this assessment. The independent evaluation that is currently under way will provide more detail of the individual behavioural responses that are being made.

Baroness Hollis of Heigham: My Lords, the Minister wants social tenants with a spare bedroom to free up their homes for the waiting list by moving to smaller flats, mostly in the private rented sector, where rents and therefore housing benefit will be £50 a week or more higher. If they move, the Minister will not make his savings. If they do not move and are fined, the Minister will not make his policy of helping those on the waiting list. The Minister can have his savings or he can have his policy, but he cannot have both. Which does he want?

Lord Freud: My Lords, you have to look at the whole transaction, a bit like a housing chain. If a single person moves into the private rented sector out of a large social sector home, clearly that frees up room for people to move into that home from the private rented sector. That is where either you get a much more efficient allocation or you get the savings.

Lord German: My Lords, in Questions to the Prime Minister on 27 November on the spare room subsidy clawback, Mr Cameron said that,
	“what we have done is to exempt disabled people who need an extra room”.—[ Official Report , Commons, 27/11/13; col. 254.]
	For families with a disabled child, there is a blanket exemption. However, households with a disabled adult are subject to the vagaries of local councils using the discretionary housing payment, which has not been great. Does my noble friend agree that now is the time to make a clear exemption, as we do for disabled children, for households with a disabled adult who need a spare room, so that the Prime Minister’s statement of 27 November can be carried out?

Lord Freud: My Lords, the difference between children and adults is that adults can adapt their circumstances in a way that children cannot. We have gone through a judicial review of this policy as it relates to disabled adults. The judges found that it was impossible to reach a coherent definition and that the discretionary housing payment system was created to look after people in those circumstances.

Baroness Farrington of Ribbleton: My Lords, the Minister recently told the House that a review would be conducted and the results published. I think that the date that he gave was after the next general election. Does he accept that there is grave concern all around the House about the result of this policy and will he undertake an interim review as soon as possible to satisfy the concerns raised by Members of your Lordships’ House?

Lord Freud: I am pleased to confirm that, as I have said in the past, the interim review is due to be published in the spring of 2014. I will be most pleased to discuss the findings of that review with Members of the House, who I suspect will be keen to have that dialogue.

Baroness Browning: My Lords, the National Debtline has announced today that the most rapid growth in personal debt is in the area of rent arrears. In the context of the Question asked by the noble Baroness, Lady Hollis, will my noble friend agree to examine on a regular basis the way in which personal debt is accounted for by rent arrears and to identify exactly why that is and what remedies might be brought in to suppress the increase of personal debt in this way?

Lord Freud: My Lords, my noble friend is absolutely right that personal debt in this country is a major problem. There has been a series of important reviews of that in recent weeks. I am looking at it very closely in the context in particular of the introduction of universal credit. That is one of the factors in the review that I mentioned in response to the last question and I will keep it very much in mind.

Lord Best: My Lords, will the noble Lord join me in correcting a mistaken view that some have expressed that reducing support for people in council houses and housing association properties who are deemed to have a spare room is only repeating a measure already in place for private sector tenants? Does he agree that the arrangements for private sector tenants are quite different, in that people are given a sum of money—the maximum that they can spend—and are sent out to find a property on the private market,
	balancing the number of bedrooms against the location and other factors? In particular, a major difference between the two sectors is that in the private rented sector these measures apply only to new and future tenancies and have not been applied retrospectively to people in existing tenancies—namely, the 660,000 people who find themselves covered by a measure that relates to the past and not, as in the private sector, one that relates to future tenancies.

Lord Freud: My Lords, clearly there is a difference between the structures of the social and the private rented sector arrangements but the objective is the same. The taxpayer provides the appropriate amount of money to house that individual or family in the same way in the private rented sector as in the social rented sector.

Pensions
	 — 
	Question

Lord Foulkes of Cumnock: To ask Her Majesty’s Government what action they propose to take on the report by the Financial Services Consumer Panel concerning the selling of pensions annuities.

Lord Newby: My Lords, when people have saved up for retirement, the Government agree that they should get the best from their retirement savings. That is why we are already taking action to combat excessive pension charges. It is also why we set up the Open Market Option Review Group, which introduced measures to prompt consumers to shop around for an annuity and secure a better retirement income. The Financial Conduct Authority is also looking, through its thematic reviews, into the important issues that this report raised. The report is a useful contribution to ongoing work in this area.

Lord Foulkes of Cumnock: My Lords, will the Minister join me in thanking the Daily Telegraph and Daily Mail for exposing this latest example of financial institutions cheating their customers? Will he ensure that the Financial Conduct Authority deals with them firmly, as it did yesterday with RBS and Lloyds? Could he also look at some way of ensuring that the people who are punished are those in the institutions responsible and not the bodies themselves, which pass on the costs to their long-suffering customers?

Lord Newby: My Lords, I am not sure that I ever thought I would say this, but I join the noble Lord in thanking those newspapers that have drawn yet another financial problem to more general interest and view. The Financial Conduct Authority has new powers and is already showing that it intends to use them very rigorously. It has powers in respect of individuals as well as institutions, and will use them.

Lord Forsyth of Drumlean: My Lords, will my noble friend, in making his statement that it is important that those who have saved throughout their life get the best return on their savings, bear in mind that the Government’s quantitative easing programme is one of the major reasons that annuities are so poor? Can we have some indication of when the Government might abandon QE?

Lord Newby: My Lords, we have discussed many times the fact that low interest rates are a key determinant in supporting growth, and that growth is in the long-term interest of the entire community. The Bank of England has given forward guidance in respect of when interest rates might rise. Monetary policy is firmly in its purview rather than the Government’s.

Lord McFall of Alcluith: My Lords, the research in this report indicates that insurers can make £35,500 out of a £100,000, 25-year pension pot. That illustrates that this is a dysfunctional market. The Government have been told this for years. Given that the annuities market will double by 2015, is there not a case for the Government to consider a standing commission on pensions, which can look at the industry and pensions in the long term to ensure that people are not ripped off and that they get the best deal for their retirement?

Lord Newby: My Lords, as the noble Lord will be aware, the big new development in pensions is around auto-enrolment. In this area, the Government have set a cap on allowable fees, precisely to deal with the problem of high fees going forward. More generally, the FCA is undertaking a thematic review of annuities, which will look at fees among other things. There is a lot going on and we will see action without needing to set up any further bodies to bring it about.

Lord Phillips of Sudbury: My Lords, would the Minister not accept that, after the latest in an apparently endless series of disillusioning revelations about the cynicism of too many parts of the financial sector in particular, it is about time that we as a Parliament, and indeed the Government, made clear to the people of this country that there is a limit to what we can do in these issues? They bear on profound moral issues. Perhaps the time is right for us to, in effect, throw the ball back into the court of Mr and Mrs Britain and call upon them to exercise their own, individual moral autonomy and power to effect some sort of reformation of what is becoming a very depressing state of affairs.

Lord Newby: There are obvious limits to what government and Parliament can do, but I have always believed that one of the very important things that Parliament can do is to act as the bully pulpit and set out what it thinks is the correct way of behaviour. In terms of the financial institutions we have instituted, as the noble Lord knows, a number of pieces of legislation in this area but, as the Parliamentary Commission on Banking Standards pointed out, culture is very important—that is, the culture of the industry and also of consumers. A big problem around pensions
	in particular is that virtually no consumer understands the product that they are buying, which makes it very difficult for us to get people to accept responsibility. They find it very difficult to get to grips with a pretty complicated product.

Lord Tunnicliffe: My Lords, unusually, the report of the Financial Services Consumer Panel on annuities is even more alarming than the press reports. Its final paragraph states:
	“The chances of mass consumer detriment”—
	I emphasise, mass consumer detriment—
	“are, in our judgement, too high to trust to current market-driven solutions alone: hence our recommendations for further regulatory and government-led structural reform”.
	Will the Minister commit to using the Pensions Bill to require a regulator to set best practice standards for those offering annuities and to require pension schemes to take responsibility for directing savers to brokers who meet those standards?

Lord Newby: My Lords, there is already the open-market option review, which brings together the Government, the regulator, providers and consumer groups. It is looking at how we can promote best practice. There is also an ABI code which, for example, requires insurers to no longer send out application forms so that people take out an annuity automatically with the company with which they have their pension pot. We are bearing down on this issue, and what the report that was produced only this week shows, is that there is further to go. However, we have the structures in a new regulatory framework, and we are determined that it will work.

Business of the House
	 — 
	Timing of Debates

Moved by Lord Hill of Oareford
	That the debate on the Motion in the name of Lord Dubs set down for today shall be limited to three hours and that in the name of Lord Norton of Louth to two hours.
	Motion agreed.

Health: End of Life
	 — 
	Motion to Take Note

Moved by Lord Dubs
	That this House takes note of the case for patient choice at end of life.

Lord Dubs: My Lords, my aim in this debate is to consider, in its widest sense, end-of-life care, to note what progress has been made in recent years and to look into the future. I accept that while some of the
	issues will command broad support in this House and in the country, others are controversial. But there is one thread running through all this: how we can best achieve informed patient choice. We are better able to discuss death today than ever in the past and it is becoming less of a taboo subject. This is in large part down to the work of the hospice movement, other stakeholders such as the Dying Matters coalition, successive Governments who have implemented the end-of-life care strategy, and the ongoing public and parliamentary debate on assisted dying led by Dignity in Dying, to which I owe my thanks for some of the help that it has given me in this debate, and indeed in the past.
	I would like to say a little about what has influenced my own views. I remember, as vividly as if it were yesterday, the debate on my noble friend Lord Joffe’s Bill in this House some years ago. I listened hard to that debate; at the beginning of it, I was not even certain where I stood, but by the time I had heard the arguments I realised that I could not vote to deny other people something that I would want for myself. So of course I supported the Bill, and have been a supporter of that cause ever since.
	It was at about that time that a friend of mine with motor neurone disease was dying. I went to see him, his wife and children around him, and he tapped out a message to me on a keyboard, the only way in which he could communicate because he was no longer able to speak. His message was that I should support the change in the law to permit assisted dying—a very passionate plea from a person who could not actually speak with passion. That was almost the last time I saw him because he died at home shortly afterwards. It moved me enormously in my attitude to this whole issue.
	It is worth noting that palliative care, an area of healthcare that focuses on alleviating the suffering of patients, is, by comparison with other established forms of healthcare, a fairly modern development. I believe that palliative care merged with the hospice movement in the late 1960s, and since then it has made great progress to ensure that patients at the end of life can die comfortably and peacefully. Of course there is still some way to go in making this a reality for all people at the end of life, but I believe that this House will be united in its admiration for how far we have come in such a short space of time and would like to join with me in expressing my admiration for the healthcare professionals, in both the NHS and the wider hospice movement, who have dedicated their lives to alleviating the suffering of their patients.
	However, we know that the journey to date has not been without difficulties and areas of controversy. The House will be aware of the recent concerns raised in the media about the Liverpool care pathway for the dying. These concerns resulted in an independent review by the noble Baroness, Lady Neuberger, in July, which recommended the phasing out of the pathway, a recommendation that the Government accepted. There are other documented cases where standards of care at the end of life have fallen well short of what we expect, some of them highlighted by the Patients Association.
	I understand that in the near future the Government will make proposals to replace the Liverpool care pathway, and I wonder if the Minister can give us some idea of when this might be expected.
	This debate comes at a critical time for the development argument of end-of-life care. The Government have asked NHS England to lead an alliance of stakeholders in creating and delivering,
	“the knowledge base, the education, training and skills and the long-term commitment needed to make high quality care for dying patients a reality, not just an ambition”.
	Separate to the review, and as a matter of profound conscience, my noble and learned friend Lord Falconer has tabled an Assisted Dying Bill that awaits its Second Reading in, I believe, the next Session of Parliament. I hope that with the combination of the NHS England review and my noble and learned friend’s Bill we will be able to develop a broader approach to end-of-life decision-making in the next two years, an approach that puts patients first.
	I turn to what I understand by patient choice. Some people are uncomfortable about that concept. There is a concern that the patient may not make a free choice but may somehow feel under pressure from those close to him or her, possibly not always from worthy motives—I have had that point put to me. However, it is only right to point out that there are no safeguards at all in going to Switzerland to have an assisted death provided that one can afford the air fare, so my noble and learned friend’s Bill would actually improve the situation significantly by having safeguards in the process. The issue is whether there can be satisfactory safeguards for an ill patient who may also be in considerable pain. I believe firmly that this can be done otherwise I would not support changes in the law, because I believe that these safeguards are essential.
	I should add that there are those who oppose people’s choices at the end of life because they are based on sincerely held—although, I believe, faulty—religious beliefs. To me, though, and I suspect to most people, the desire not to suffer or to see others suffer against their wishes is a worthy sentiment, and I see greater patient choice as ensuring that people do not suffer against their wishes at the end of life.
	Of course, suffering is subjective. To some, the inability to spend their final days in familiar surroundings may cause distress; to others it may not. Some may have a higher threshold of pain than others or a stronger desire to live. Within reason, though, and with sufficient resources, informed choice can surely accommodate individual wishes and preferences that would enable the patient to have what they themselves consider to be a good death.
	The End of Life Care Strategy published by the previous Government in 2008, and taken forward by the present Government, has led to increased investment in end-of-life care and more people dying at home. The strategy recognises the importance of treating people,
	“as an individual, with dignity and respect; being without pain and other symptoms; being in familiar surroundings and being in the company of close family and/or friends”.
	The right,
	“to be involved in discussions and decisions about your health and care, including your end of life care, and to be given information to enable you to do this”,
	is now also reflected in the NHS constitution.
	Furthermore, I understand that the Government are giving active consideration to the merits of the Macmillan campaign, championed by my noble friend Lord Warner in this House, to provide free social care at the end of life so that people can stay in their own home with adequate support.
	I do not believe that choice is simply matter of saying, “I want to be at home”. Choice is wider than that, but I do not want to diminish the importance, for those who want to do it, of dying at home. I believe that there are other people who would also like greater choice over their care and treatment at the end of life regardless of where that care is delivered. We need a broader approach to patient-centred care at the end of life. On this I wish to commend the work of Sue Ryder and its excellent report A Time and a Place: What People Want at the End of Life. It states:
	“End of life care policy and practice has, for some years, focused on ensuring people die in their preferred place of death and usually at home. But this focus on where people die—rather than what they want at the end of life—has inhibited personalisation and informed choice for patients and their families. It has led to a lack of proper scrutiny of the experience of dying at home and left other settings neglected when it comes to developing them as good places to die”.
	The report goes on:
	“People’s first priority at the end of life is to be free from pain and discomfort (78% of respondents said this would be important to them), followed by being surrounded by their loved ones (71%) having privacy and dignity (53%), and being in familiar surroundings and being in a calm and peaceful atmosphere (both 45%)”.
	It concludes:
	“No care setting is perfect—home, hospices, hospital and care home all have their weaknesses—but all can do more to ensure that no matter where a person dies, the experience will deliver as much as possible on the outcomes people value at the end of life”.
	Turning to what sort of care people wish to receive at the end of life, a poll commissioned by Compassion in Dying, the partner charity of the campaign organisation Dignity in Dying, recently found that a majority would want little or no medical intervention at the end of life. Specifically, it found that more than half of adults—57%—would want only comfort care, 13% would want limited intervention, and just over one in 10—12%—would prefer all available treatment, so people have a range of views about what they want, which is why I believe that choice is such an important factor. Relevant recommendations have been made by Sue Ryder, Compassion in Dying and other stakeholders which I would urge the Government to consider.
	Let me draw attention to one specific recommendation by Compassion in Dying, which is that there should be a positive duty on healthcare professionals to inform patients of all their rights at the end of life, including the ability to make an advance decision, or a health and welfare lasting power of attorney, if there is a reason to believe that patients may lose capacity.
	The wider issue of assisted dying is surely one of conscience, and it is a matter for Parliament to resolve rather than the Government. I welcome the Assisted Dying Bill that has been tabled by my noble and
	learned friend Lord Falconer. It seems inevitable, as an issue of conscience, that this choice must be enacted and safeguarded separately from other initiatives to promote patient choice at the end of life. I recognise there is opposition from some quarters to this approach—I have heardit before in this House and in Grand Committee—but I sincerely believe that at the end of life people have the right to choose to be free from intolerable pain and discomfort, provided it is their free choice.
	Of course palliative care can alleviate much pain and discomfort, but not in all cases for all people, so assisted dying, with safeguards, is but one of many legitimate choices dying patients should have.
	I return to the experience in Oregon, which of course introduced assisted dying about 15 years ago. All the assessments conclude that the law worked safely. Eligibility has never been extended beyond terminal illness, nor has there been pressure for it to be extended. Numbers are very low. Assisted deaths have remained stable since 2008 at around 0.2% of all deaths per year. There is no evidence that potentially vulnerable groups are negatively affected. Around 40% of dying people who meet the strict safeguards to obtain life-ending medication never use it, simply taking comfort in having the option. That is a crucial point. It means in practice that people in Oregon who are terminally ill and in great pain can be in hospice care, knowing that if things become intolerable for them, they can opt to take the medication that will end their lives. Because people in Oregon feel that they are in full control, they seldom exercise that choice. That, to me, is one of the particular arguments in favour of a change in the law.
	Compare that with the position here, where people have to agonise over whether to make the journey to Switzerland before they are really ready in their own mind to end their life. Yet they worry that they may be too ill to make that journey. This seems to be an intolerable dilemma which we impose upon people. Assisted dying and palliative care are not, and should not be, alternatives. As was stated by the noble Earl, Lord Arran, in a debate last week, the former chief executive of the Oregon Hospice Association, Ann Jackson, told the Select Committee on my noble friend Lord Joffe’s Assisted Dying Bill that the Oregon Act had not adversely affected the hospice movement. In fact, hospice provision had improved in Oregon since the passage of the Act. Last year, 97% of those who had an assisted death in Oregon had been enrolled in hospice care.
	Assisted dying and palliative care are therefore complementary. Choice at the end of life does not begin and end with where you die. Within safeguards, and in line with public opinion, dying people should not have to suffer against their wishes. It is time for change. If we entrust dying patients to refuse potentially life-prolonging treatment, we should also entrust them to choose whether they want an assisted death.
	We had a debate in Grand Committee last week. I was not very happy with some of the comments made from the government Front Bench, particularly using words such as “killing” and so on. It limited the argument and was not very helpful. Present law and practice allow doctors to administer sufficient doses of
	pain relief to end a patient’s life, so long as they can argue that it is not their direct intention to end life but to minimise suffering: the principle known as “double effect”. These things occur, so there is not that steep threshold over which we should go, as has been suggested.
	The beauty and nature of choice is that it accommodates different views. Within reason, it accommodates the views of those who wish to prolong life as much as it accommodates the views of those who wish to hasten death at the end of life. While it is the job of Parliament, the Government and healthcare professionals to ensure that people’s choices are informed at the end of life, where necessary through upfront safeguards, we must also find it within ourselves to respect people’s choices even when they differ from ours. That is the message I want to leave with your Lordships today.

Baroness Morris of Bolton: My Lords, we will all of us die one day, and how we die is as important as how we live. This is about the best possible care at the end of life, and the choices which that affords. I am grateful to the noble Lord, Lord Dubs, for giving us the opportunity to debate this important issue.
	As a society, we are becoming personally less familiar with death. At one time, death was an integral part of life. Most deaths took place at home, with family present or nearby. My husband and I both come from large Irish Catholic families and it was the usual practice for your loved ones to be laid out at home for family and friends to pay their last respects before burial. However, with advances in medical science—advances for which we are all enormously grateful—death has increasingly become a clinical act that takes place in hospital, often after an emergency admission to an acute ward and, sadly, all too often in isolation. We have come to believe that medicine has the answer for everything.
	We cannot recreate a society from another age, and each age must shape its own way. However, it is a fact, as the noble Lord, Lord Dubs, said, that when questioned, most people say that they would wish to die at home. We should strive to make that possible, wherever possible. That means greater investment in community care. It also means building on the investment which successive Governments have made in the development of specialist palliative care—an investment that has made this country a world leader in end-of-life care.
	Those are the choices that I want to see embraced at the end of life. What I do not wish to see is the right to choose when to die, with assisted suicide enshrined in law as one of those choices for some people.
	There is nothing more distressing than witnessing someone you love in pain and with little hope of recovery. I completely understand the honourable intentions of those who support a change in the law to license “assisted dying”. However, in reality that means licensing doctors to involve themselves in deliberately bringing about the deaths of some of their patients.
	In the Bill of the noble and learned Lord, Lord Falconer, now before your Lordships’ House, responsibility for assisting suicide is placed on the shoulders of
	doctors. However, most doctors do not want that responsibility, and nor do their professional bodies. The Royal College of Physicians has stated explicitly that a doctor’s duty of care for patients,
	“does not include being, in any way, part of their suicide”.
	We need to remember that the law exists to protect us all—especially the more vulnerable among us. It is hard to imagine anyone more vulnerable than someone who is struggling to come to terms with their mortality and who is worried about the impact of their illness on those they love. The last thing they need is an invitation to take their own life. Instead they need and deserve our unfailing care and protection.

Lord Taverne: My Lords, I strongly support the Motion so eloquently and persuasively moved by the noble Lord, Lord Dubs.
	The official position at the moment puts the law in a state that is indefensible. The Director of Public Prosecutions decides whether to prosecute those who help people suffering from an incurable disease who want to die but cannot travel on their own to Dignitas in Switzerland. She decides on a case-by-case basis, at her own discretion.
	Take a case of bank robbery. The driver who drives a bank robber to the bank and helps him escape after the robbery is clearly guilty of aiding and abetting. The Director of Public Prosecutions does not say, “I will exercise my discretion whether to prosecute, and I won’t prosecute if, say, the driver intended to share the proceeds of the robbery with his poor old grandmother”. Aiding and abetting a bank robbery is a crime, whatever the driver’s motives.
	The law about assisted suicide, as it stands, is equally clear. To help someone die is a serious crime, punishable by up to 14 years of imprisonment. But what is the difference between taking someone to Switzerland to help them to die and driving a bank robber to a bank? Both are equally guilty of a crime. However, when it comes to assisting someone to die, the Director of Public Prosecutions says, “Sometimes I will decide it is a crime and sometimes not. It is entirely for me to decide”. She would never say that in a case of assisting a bank robbery. This practice brings the whole system of justice into disrepute. It makes the law, to quote Mr Bumble, “a ass”. Indeed, that most eminent judge, the late Lord Bingham, said that the law was a mess and needed revision.
	In the past, when some laws came to be regarded as intolerable, juries would ignore the law and acquit. At one time it was a capital offence to steal goods worth more than 40 shillings. Juries were required to make two findings: did the defendant steal, and what were the stolen goods worth? If someone stole £10, juries would often find that, yes, he had stolen the goods, and decide that the goods were worth 39 shillings and sixpence, since 40 shillings was the level at which the capital offence became due. Time after time, juries made a nonsense of the law, and the law was changed.
	A vast majority of the public consistently tell pollsters that they support assisted suicide and favour a change in the law. I believe the reason is obvious. They want a
	change because so many have personal experience of the suffering undergone by a dying family member or friend. There is a mass of anecdotal evidence that, because the law is unjust, it is often disregarded by many doctors, who deliberately give some patients an overdose of morphine to end their suffering. But the law says that mercy killing is murder, for which the mandatory penalty is life, even if the act is a compassionate response to a dying person’s request for help to die. I regard that law as monstrous and intolerable.
	Perhaps one day, in cases of mercy killing or assisted dying in the most compassionate circumstances, defending counsel may remind juries of their absolute right to acquit. Not long ago, Clive Ponting, acting on principle, broke the Official Secrets Act; his jury cocked a snook at the law and acquitted him. Juries should be reminded that their absolute right to acquit is one of the great virtues of the jury system.

Baroness Hayman: My Lords, it is nearly 10 years ago that I was appointed a member of the Select Committee of your Lordships’ House on the assisted dying Bill proposed by the noble Lord, Lord Joffe, under the as ever brilliant chairmanship of the noble and learned Lord, Lord Mackay of Clashfern. It is on the question of assisted dying and legislation to implement it that I shall concentrate today. I put on record my passionate support for the hospice movement, which has come both from personal experience and from my time as a Minister with responsibility for hospices in the Department of Health. That commitment extends, as the noble Lord, Lord Dubs, said in his excellent opening speech, to all settings in which people die.
	When my own father was dying, I was deputed as the member of the family who should go and put the question to him—we thought that this was the only question—as to whether he wanted to die at home. It was a difficult conversation to have, more so because he thought that I was absolutely mad to be having this conversation. He turned to me in his way and said, “Well, dear, we’ll just have to see how it goes and what’s best at the time”. As it happened, he did die at home, but he would not have wanted to do so if that was a terribly distressing situation for my mother and it was more appropriate for him to be in another setting. That element of individuality in these choices is tremendously important.
	Like the noble Lord, Lord Dubs, I came to the Select Committee as someone without objection in principle, understanding about the hard cases and moved by them but as an ex-law student who had had it drummed into me that hard cases made bad law. Therefore, I was concerned as to whether adequate safeguards could be incorporated to make sure that there was no pressure on individuals to avail themselves of this option. My experience of taking evidence, visiting Oregon and going to other jurisdictions, persuaded me that it was possible to provide those safeguards, and I think that the Bill proposed by the noble and learned Lord, Lord Falconer of Thoroton, is particularly robust in that respect.
	There were two other things that I learnt in the course of the past 10 years. One was that no one can speak for their demographic on this issue. Different
	people take different opinions from the same sort of background. I cannot speak for 64 year-old female Jewish parliamentarians in good health. There are probably quite a few of them around. I cannot speak for that group. There are differences of opinion among doctors—I am a member of the General Medical Council—nurses, people with disabilities, people of faith and, indeed, ministers of religion. However, overall, there is consistent general public support for a change in the law on this issue.
	The second thing I have learnt concerns the insurance cover value of assisted dying legislation, to which the noble Lord, Lord Dubs, referred. In Oregon, the latest figures for 2007 show that 9,800 people considered a prescription for assisted death out of 30,000 who died. Just over 1,000 talked to a doctor about the prescription. Of these, 85 received the prescription and only 49 used it. However, other people gained great confidence and strength from knowing that if life was intolerable at the end, something could be done. I gain confidence from the fact that I have in place an advance directive about what should happen to me. I think that that confidence should be extended to others through legislation.

Lord Bishop of Sheffield: My Lords, I must begin by thanking your Lordships for the warmth of welcome extended to me here. Thank you also to the staff for their guidance and help. I look forward very much to serving with you in this House and count it an immense privilege to be here.
	It is particularly poignant for me to contribute to this debate on patient choice at the end of life as my own father is very seriously ill. Over the last few days I have been involved in a number of conversations with medical staff and my close family about the questions before us today. I am sure that these conversations are familiar to many noble Lords. The matters we debate are of profound importance to those who are near the end of their life, and to their wider families.
	The diocese of Sheffield, where I now serve, covers most of south Yorkshire and parts of east Yorkshire. Its communities are vibrant, coherent, friendly and welcoming. Its manufacturing is alive and growing. There are vigorous partnerships between industry, civic life and the universities, including in the area of healthcare. Its people are deeply committed to their local institutions, including their National Health Service.
	The city of Sheffield has this year embraced a new commitment to fairness and equality through its Fairness Commission and aims to become the fairest city in Britain in the coming years, including in equality of access to all forms of healthcare.
	Like many others, I am grateful to those who have produced the independent review of the Liverpool care pathway. There is much in their report to be welcomed: the valuing of end-of-life care as a specific discipline, the move away from the language of pathway to a personal care plan, the greater shift to patient choice, and greater clarity in decision-making. Like others, I welcome particularly the continued valuing of the hospice movement. The greater shift to patient choice commended in the review does not, of course,
	include extending patient choice to physician-assisted suicide, something to which I remain opposed and which seems a very different kind of conversation.
	I also welcome the work of the Leadership Alliance for the Care of Dying People, and in particular the collaborative partnership and way of working it has established between the medical profession, patients and their families. I note the sense of urgency among those involved in end-of-life care with whom I have spoken that proper provision should be in place soon in every place to replace the Liverpool care pathway, lest an imperfect system be made even worse by a period of uncertainty and confusion.
	More Care, Less Pathway calls for a proper national conversation about death, which the Leadership Alliance is taking forward. This takes us to the heart of the issue. The death of someone we love, our own death, is far more than the cessation of life for medical reasons. Death is an existential event which raises and asks significant questions. Those questions are often suppressed, masked by humour or denied, but surface in times of vulnerability throughout our lives. What is it of the human person which endures? What light does death cast on the way in which we live? What is a good death? What does it mean to come to terms with our mortality and, from the Christian perspective, our vocation to eternity?
	For all these reasons and more, the ministry of chaplains in our hospitals and hospices remains a vital part of end-of-life care. Chaplains are present to minister to those of all faiths and of none. They are drawn, of course, from every faith. They are present to offer spiritual support to the dying and to the bereaved, to patients and staff. They are a vital part of the team in end-of-life care as a specialist resource, as experts able to offer training to colleagues and as a point of referral in moments of crisis. I invite the Minister in the response to this debate both to affirm the key role of chaplains in this context and to ensure that the part they play is written clearly into the documents which will shape end-of-life care into the future.
	I look forward very much to playing my part in the business of your Lordships’ House.

Lord Alton of Liverpool: My Lords, it is a particular pleasure for me both to thank the right reverend Prelate the Bishop of Sheffield for his thoughtful and poignant maiden speech, and to welcome him to your Lordships’ House. I see that, like Moses, he chose to read from a tablet.
	I am married to an Anglican whose father and grandfather were, for more than 60 and 50 years, Anglican priests, and there are eight ordained Anglican clergy crossing the generations on my wife’s side of the family. As an outsider, I have seen something of the extraordinary selflessness that characterises the men and women from whom the right reverend Prelate has been drawn.
	Steven Croft is a Yorkshireman who, after graduating from the University of Oxford, studied for the priesthood and obtained his doctorate at Durham. After serving in parishes and as a diocesan adviser in Wakefield, he
	returned to Durham with his family as warden of the university’s Cranmer Hall, St John’s College. This required him to lead the training of men and women for Church of England ministry. He thrived in his new responsibilities, wrote widely about his experiences as a parish priest and began to express increasing concern about the urgent need for the church to engage with a society that has been drifting spiritually but where the Christian faith is needed like never before.
	Shortly after Rowan Williams—now the noble and right reverend Lord, Lord Williams of Oystermouth—was appointed as the Archbishop of Canterbury, the right reverend Prelate became Archbishops’ Missioner and Fresh Expressions Team Leader. For four years he oversaw the emergence of Fresh Expressions, an initiative of the most reverend Primates the Archbishops of Canterbury and York, in conjunction with the Methodist Church. Fresh Expressions encourages and resources new ways for the church to engage with the world. The movement has resulted in thousands of new congregations being formed alongside more traditional churches. The right reverend Prelate is known as a very shrewd and strategic thinker. The energy and determination that he has brought to his work thus far will prepare him perfectly for his duties in your Lordships’ House. Sheffield is lucky to have him. I have no doubt that, as the years pass, we will hear many more thoughtful and challenging contributions to our proceedings, and I know that I speak for all sides of your Lordships’ House when I thank him again for making such an excellent start with his maiden speech.
	It was an illustrious English woman, a devout Anglican, Dame Cicely Saunders, whom I was fortunate to meet, who was the founder of the modern hospice movement in England. Dame Cicely trained as a nurse, a medical social worker and finally as a physician. Involved from 1948 onwards with the care of patients with terminal illness, she founded St Christopher’s Hospice in 1967 as the first hospice linking expert pain and symptom control, compassionate care, teaching and clinical research. St Christopher’s has been a pioneer in the field of palliative medicine, which is now established world wide. Like the late Lady Ryder of Warsaw, Sue Ryder, whose charity the noble Lord, Lord Dubs, referred to earlier, Dame Cicely was resolutely opposed to assisted suicide and euthanasia. She once said:
	“You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die”.
	In declaring a non-pecuniary interest as a patron of two hospices, I stand with the hospice movement, the disability rights groups and the British Medical Association in believing that we should never confuse the importance of providing end-of-life care with the legalisation of euthanasia. Were the law to change, we would see the emasculation of the hospice movement but we would also see a fundamental change in the relationship between doctors and their patients, especially the vulnerable.
	Nor does experience overseas, which has been referred to, encourage me to change my mind. We are told that in the US state of Oregon, one of the handful of places where these practices have been legalised, everything is fine and the law is working well. That is a highly questionable assertion. There is no audit system in
	place for Oregon’s law. It is totally dependent on the honest reporting of doctors. What we do know, from the annual statistical reports, is that the number of legal assisted deaths is rising year on year. In 2012, the number was nearly five times that in 1998, and the latest figure is the equivalent of between 1,100 and 1,200 such suicides per annum in England and Wales. It is claimed that the rising trend has levelled off. It has not. The official data show that the death rate from assisted suicide has increased by over 20% in the past five years.
	There is another reason for being cautious about Oregon. The latest report states that nearly half of those in Oregon who asked for lethal drugs with which to end their lives listed as a reason that they feared being or becoming a burden on their families. In today’s society, where we are living longer and where younger generations are often burdened with debt and other responsibilities, such fears are all too natural, and I fear that they will become even more so. For those reasons, I hope that we will resist the temptation to legalise something which on two occasions your Lordships have voted against.

The Earl of Arran: My Lords, last week I spoke of my experience as yet another member of your Lordships’ Select Committee on the Assisted Dying for the Terminally Ill Bill. I travelled to Oregon, as did the noble Baroness, Lady Hayman, and the noble Lord, Lord Taverne, in 2004 to see how the Death with Dignity Act works in practice, it having been enacted there 10 years before. I wish to talk further briefly on Oregon simply because we think that the Act works well.
	We often hear from opponents that there has been a meteoric, inexorable rise in the number of people who have an assisted death in Oregon. Quite aside from the fact that a modest rise should be expected in a new system such as this—proving, surely, that the system is working well—we are still looking at a very small number of cases each year. There have been fewer than 80 cases each year, representing less than a quarter of 1% of all deaths in that state. In this country, as has already been said, that would amount to approximately 1,000 to 1,200 people.
	What better proof can there be of the law’s effectiveness than the continued support of Oregonians themselves? They voted to retain the Act by 60% to 40%, and polling consistently confirms that between 75% and 80% of Oregonians continue to support the Death with Dignity Act.
	I can suggest several reasons why that support remains so high. First, as I have already said, assisted dying is not running rampant across Oregon. It is used by a small number of people who suffer from intractable distress. However, while assisted dying is not used widely in Oregon, it offers reassurance—again, as has already been said—to a great many people. Forty per cent of those who request medication that would allow them to have an assisted death and meet the safeguards to access the medication do not use it and die naturally. Only around 1% or 2% of those who begin the discussion with their doctor about assisted dying actually go on to take life-ending medication.
	The Act offers reassurance to dying people that they may avoid unnecessary suffering; it offers reassurance to healthcare professionals that they may discuss openly and frankly with their patients the whole range of choices at the end of life; and it offers reassurance to family members that they need not face the impossible moral dilemma of breaking the law and helping a loved one to die, as is the case in this country. The fears raised by those who are opposed to a change in the law have simply not materialised. There are no documented cases of abuse in Oregon. Vulnerable people are not disproportionately affected by the Death with Dignity Act. There have been no public calls to extend the Act to cover those who are not terminally ill or do not have mental capacity, proving that the alleged slippery slope does not exist. Indeed, assisted dying is now law in the states of Washington, Denver and Montana.
	As I said last week, palliative care continues to play a vital role alongside assisted dying in Oregon, showing that they are not mutually exclusive. Of course, we must offer excellent palliative care for all, but we must also acknowledge that some people who are dying, even with the very best palliative care, will suffer at the end of life. For this small but significant minority of people, our current law is not working. As so often happens, it tends to be society as a whole that eventually brings about the great humanitarian reforms. Witness, first, the Sexual Offences Act 1967 on homosexual reform, which incidentally was introduced by my father in your Lordships’ House; and, secondly, the Abortion Act 1967 and further such legislation in 1990. Ultimately, it is the will of the people that pushes open the barriers and Parliament has to act. Both of those reforms involved the possibility of death. This Act deals directly with death and it is critical therefore that we get it right. Against a background of a growing majority of public support, I believe that we have got it right.
	We have been arguing among ourselves for a long time—too long—about this reform. Now, dithering is done and Parliament must act soon—and very soon. Finally, none of us here today asked to come into this world. Should we therefore not have a choice to say how we might wish to depart from it?

Lord Joffe: My Lords, I, too, join the welcome of the noble Lord, Lord Alton, to the right reverend Prelate the Bishop of Sheffield, and I look forward to his contribution to the important issues that this House considers.
	The starting point for the debate must surely be the law on personal choice in England and Wales. The law has been considered in a large number of cases and was admirably summarised by the noble and learned Baroness, Lady Butler-Sloss, in her judgment in 2002 in the case of Ms B v an NHS Hospital. In it she endorsed the 1993 judgment of Lord Donaldson of Lymington in Re T (Adult) when he held that,
	“the patient’s right of choice exists whether the reasons for making that choice are rational, irrational, unknown or even non-existent”.
	Likewise, Robins, Judge of Appeal, in the case of Malette v Shulman, held that:
	“The right to determine what shall be done with one’s own body is a fundamental right in our society. The concepts inherent in this right are the bedrock upon which the principles of self-determination and individual autonomy are based”.
	It is against this law that we should be considering the various options for patient choice at the end of life. These include the following options. Option 1, palliative care: where it is available it is the preferred option for the overwhelming majority of patients. However, despite the excellence of UK palliative care it is not the solution for a small but significant minority of patients—a point accepted with a measure of reluctance even by palliative care professionals.
	Option 2, refusal of further life-saving medical treatment: all patients have this right to bring their suffering to an end.
	Option 3: patients have the right to starve themselves to death by refusing either food or water. This takes great courage, self-determination and suffering because weeks can pass before the patient withers away.
	Option 4, terminal sedation: the patient is so heavily sedated that he or she remains unconscious for all or most of the time until they die. However, it is not certain that patients can insist upon this option.
	Option 5, a request by patient for removal of life-saving equipment: based on the case of Ms B, doctors are obliged in law to accept an instruction from mentally competent patients to remove them from the equipment so that they can end their suffering.
	Option 6, the double effect option: the doctor at the request of a patient can prescribe potentially lethal medication to control the patient’s pain which could end the patient’s life.
	Option 7, the Director of Public Prosecutions option: provided that the patient has mental capacity he or she can be assisted to die by any person except a doctor if the assistance was given on the grounds of compassion.
	Option 8, assisted dying: this is not yet an option but one wonders why not in the light of all the options open which are dependent on choice. This should be a compassionate option but it is currently not available because our law prohibits it. This is why the noble and learned Lord, Lord Falconer, has introduced the Assisted Dying Bill to change the law so that mentally competent patients who choose that option can end their suffering through ending their lives.
	The only limitations upon patients making choices on their own lives is that they should have mental capacity and should not, when selecting their option, put vulnerable members of society at risk. In the case of assisted dying, this risk would be prevented by an array of safeguards introduced in the Bill of the noble and learned Lord, Lord Falconer.
	In congratulating the noble Lord, Lord Dubs, on introducing this debate and agreeing with his unqualified support for the Bill of the noble and learned Lord, Lord Falconer, I ask the opponents of that Bill one question, which so far they have never answered: what option do they propose for the suffering of terminally ill patients for whom palliative care is not the solution and who make an informed decision to end their
	suffering by ending their lives? Surely that option cannot be that they continue to suffer terribly until they eventually die.

Lord Ahmad of Wimbledon: My Lords, before the next noble Lord rises to his feet, I remind all noble Lords that this is a time-limited debate. That means that when the clock shows “4”, they should look to conclude their remarks.

Lord Purvis of Tweed: My Lords, I am new to your Lordships’ House but not new to this issue. It is a privilege to follow the noble Lord, Lord Joffe, as it was the fact that his Bill did not cover Scotland that was, in part, the reason for me lodging a Private Member’s Bill in the Scottish Parliament in 2005.
	My Bill did not propose euthanasia, and nor did it concern all adults. It did not concern the elderly, the infirm or the depressed. It concerned mentally competent adults coming to the end of a terminal illness who were seeking to be able to choose the precise timing of their death. Many of those who opposed my Bill did so by opposing things that it did not stand for. The issue is now being carried forward ably in the Scottish Parliament by the independent MSP Margo MacDonald.
	It is a personal sadness to me that in the eight years since my proposal people have continued to come to the end of their life without the legal protection for them to choose how to spend their final days. The law gives some protections, but they are primarily not for the patient.
	After a landmark case in Scotland in 1996, the then Lord Advocate, the noble and learned Lord, Lord Mackay of Drumadoon, issued a statement that he would not authorise the prosecution of a doctor if the doctor, acting in good faith and with the authority of the Court of Session, withdrew life-sustaining treatment from a patient with the result that the patient died. Commenting on the case, Professor Sheila McLean of Glasgow University’s Institute of Law and Ethics in Medicine said:
	“What our law does, therefore, is to endorse decisions which will result in the deaths of certain patients (most notably those who cannot express a preference) but not those who are competent to ask for aid in dying”.
	There are further protections for the medical professions if they stop medical treatment that is keeping a patient alive but not making them better. Such futile treatment, as so defined, can be withdrawn, as they describe, without legal repercussion. Indeed, mention has been made in the debate of the double effect. However, if a mentally competent patient who is coming to the end of their life wishes to choose the precise timing of their death, no protection is allowed for—unless, of course, they wish to starve without hydration and to have their treatment withdrawn.
	What is also indefensible is the current state of affairs in Scotland, where people do not even know if they may be prosecuted for supporting the choice of a patient to travel somewhere that does afford them that protection. As noble Lords will be aware, the DPP guidance does not apply to Scotland. The previous guidance had been provided for the medical professions,
	but successive Lord Advocates have repeatedly refused my calls for greater clarity for those who are coming to the end of their lives. This is quite simply a horrendous status quo, and the Scottish authorities need to act to remedy it.
	I led a debate in the Scottish Parliament in similar terms to those of the noble Lord, Lord Dubs, to whom I pay sincere tribute for bringing this issue before us today. The debate was held in the Scottish Parliament on Wednesday, 26 March 2008. The preceding Saturday I had been with a lifelong friend and mentor of mine who was in palliative care in Berwick-upon-Tweed. In the debate I said:
	“He is a man of strong faith. He told me that he knows that he is leaving this world for a better one, and that his time to do that is now upon him. He has asked for treatment to be withdrawn and is now receiving only increasing amounts of palliative medicines ... He told me that he is not afraid to die, and he has made the arrangements for his funeral. He has instructed that it will be forbidden for anyone to cry at his thanksgiving … My friend has celebrated life all his life and has helped others … he has asked us, if we remember his life when he is no longer with us, to ensure that other people’s wishes can be respected as they approach the end of their lives, if his wishes cannot be respected”,
	in asking for assistance at the end of his. His refusing medication and then food and water finally took its toll and, three days after my debate, he died.
	Let us in this place recognise that we enhance society, we strengthen life and the love of our loved ones, and we cherish life more, if those who request it are given the protection in their final days that is currently denied them.

Lord Brown of Eaton-under-Heywood: My Lords, one day we will look back on our present law on assisted dying with the same wry surprise as we now look back on our past laws on homosexuality, capital and corporal punishment, abortion and, indeed, attempted suicide. Let it be remembered that we used to prosecute people who attempted but failed to take their own lives. I believe that the present law is not merciful, but merciless.
	Of course there are profound difficulties in devising the right legislation, with real dangers to be avoided and real concerns to be met, and of course it is imperative that nothing is done to imperil the continuing availability of the very best palliative care for those whose lives are drawing to a close. We must recognise the vulnerability of the terminally ill and ensure that they are not subject to the least pressure to end their lives a day earlier than needs be. Obviously, assistance must be given only to those of sound mind with a clear and settled intention of ending their lives early. All these safeguards seem to me to be fully enshrined in the draft Bill of the noble and learned Lord, Lord Falconer. If I have any reservations about that Bill, they are that it is too restrictive rather than too extensive in its application.
	Let us take someone like the late Mr Tony Nicklinson, whose posthumous appeal has been heard this very week by the Supreme Court, although not yet decided. Mr Nicklinson would have been unable to invoke the Bill of the noble and learned Lord, Lord Falconer, for two distinct reasons. First, his condition, insupportable
	though he found it after suffering for so long, was not terminal in the sense of dictating that he was likely to die within six months. Secondly, his case was argued on the basis that he could not himself do whatever was required actually to end his life. He needed more than assistance to commit suicide, and in fact he needed what under the present law can only be described as mercy killing. One might have thought, with his position being even more helpless than that of someone who can at least self-administer the final medication, that the law should be, if anything, the readier to allow him the choice of death.
	I am, for my part, no less interested in how voluntary euthanasia is working out in Holland and Belgium, where it applies, than in how assisted dying is working out in Oregon and the various other American states where it is practised. As far as it goes, I shall certainly support the Bill of the noble and learned Lord, Lord Falconer. Surely the underlying principle must be to promote human dignity and autonomy and to allow—always when consistent with the rights of others—the individual his choice as to how he should end his life, no less than as to how he should live it.
	My final point is one that has been made, and rightly made, by a number of other noble Lords. The great advantage of the Bill would be to give the terminally ill the knowledge that they have a safety net available if things get too terrible. In some cases, that confidence and assurance—that the time and manner of their ending is ultimately in their own hands—will not only give them peace of mind but actually prolong their lives, by deciding them against committing suicide early, while they are still able to do so unaided. That, I recollect, was very much part of Mrs Purdy’s thinking in the very last case that we heard in the House of Lords as Law Lords—the subject of that picture in Committee Room 1, “The Last Judgment”. I wish the Bill of the noble and learned Lord, Lord Falconer, the greatest of fortune.

The Lord Bishop of Chester: My Lords, I join other Members of the House in welcoming the reinforcements to the Bishops’ Benches. I will make three brief points in my contribution, the first of which does not have a direct connection with assisted suicide. We typically have long waiting lists today for transplantation surgery in this country, due to an absence of an adequate supply of donated organs. I hope that we will do as much as we can, and more, to encourage people to carry organ donation consent cards and to engender a culture in society in which transplantation and donation of organs are encouraged, especially for those whose death comes in an untimely and unchosen way. This is a matter of choice at the point of death, as are the things that we are discussing in the main part of this debate.
	Some religious communities exhibit a particular reluctance to support organ donation, which often works to the disadvantage of the members of that community who are waiting for transplantation. For some time, efforts have been made to overcome this reluctance. Earlier this week, a new interfaith organ donation action plan was launched, backed by the
	NHS and with the active involvement of a number of churches including the Church of England. I mention this simply to underline that there are various issues connected with choice at the point of death beyond the main issue of today’s debate.
	Turning to issues of choice in relation to assisted suicide, I acknowledge the strength of the momentum for legalising assisted suicide, which has been well illustrated in the contributions to the debate so far. I must acknowledge the state of public opinion on the matter, which I believe is likely to get stronger. For a society that has now embraced abortion by choice, the move to assisted suicide by choice might seem, in moral terms, rather a modest step. I am surprised that this connection is not made more often, although two noble Lords in today’s debate have acknowledged it and, in last week’s rat-a-tat-tat debate, the noble Baroness, Lady Hayter, made quite a lot of it, saying that the parallel between abortion and assisted suicide was connected by issues, as she put it, of common humanity. Whether one accepts that parallel or not, and whatever one makes of the parallel, I believe that the wider social context is crucial to our debates on this subject. Choice always has a context, and the context of our society has changed and is changing. I need to acknowledge that.
	I remain personally opposed to the change in the law that is in the Bill of the noble and learned Lord, Lord Falconer. But the question with which I wrestle is: on what basis can I prevent others who take a different view from making their choices on the basis of a change in the law? It is a somewhat open question but I think I am still persuaded that in order to sustain justice for the vulnerable in our competitive and individualistic society—the context in which we are discussing this matter—there would have to be very powerful bulwarks in the law to prevent the exploitation of the weak and vulnerable.
	Even with the safeguards in the draft Bill, changes in the law tend to create their own momentum, as has been well illustrated with what has happened with abortion. For me, that is where the problem will lie if a change in the law is based too much on the notions of choice and autonomy to which a number of noble Lords have referred very centrally. If you accept assisted suicide fundamentally on the basis of autonomous choice, how can you simply leave it to a very restricted group who are believed to be terminally ill? Logically, one day or another, sooner or later, it would have to be extended.
	That leads me to my current conclusion: that the risks inherent in legalising assisted suicide still outweigh the benefits that might accrue.

Lord Davies of Stamford: My Lords, the whole House ought to be very grateful to the noble Lord, Lord Dubs, for giving us this important and necessary opportunity to discuss this matter, although of course we do not have long enough to do it real justice.
	At the heart of the debate there is, unfortunately, an illusion or a self-deception: the suggestion that under the present regime the medical profession does not get
	involved in determining the timing or circumstances of the death of its patients. In fact, as we all know, for a number of generations it has been pretty widespread practice for doctors who have a patient who is in distress right at the end of life to accelerate the process. One doctor put it to me as, “helping the patient on his way”, generally by administering a lethal dose of an opiate or perhaps a barbiturate. This is not talked about because of course it is against the law, so there is a great deal of hypocrisy here, but we should not have any illusion about the truth.
	More frequently in recent years, the patient has been referred to a hospice and there a clinical decision is taken steadily to withdraw the necessary means of life support: resuscitation, ventilation, antibiotics and dialysis will be denied or withheld. In the case of someone who was very close to me, liquids were denied. The only thing that was administered was a sufficient amount of opiate to keep the poor patient comatose, presumably on the grounds that if she was killed by an overdose of the opiate that would be against the law, but if she was killed by dehydration that would not be against the law. She actually took two weeks to die. I cannot think of a more cruel fate.
	I support the Bill of the noble and learned Lord, Lord Falconer, for three reasons. First, it would liberate the patient and give the patient a choice; it would give the patient a vote in the important matter of his or her demise. Secondly, it would liberate the medical profession from these agonising dilemmas—the conflict between the law and the duty to do the best for the patient. The third reason goes to the heart of the responsibilities of this House. The law in this country—in any country worthy of the name of a country living under the rule of law—ought to be clear, unambiguous, respected and upheld. The law in this area is none of those things in this country. The law is cruel, anomalous and nobody takes it seriously. The previous Director of Public Prosecutions said that he would not prosecute in certain cases under this law, as has already been referred to.
	In another area, jurisprudence has changed the law in respect of establishing the double-effect rule. No doubt the GMC will be producing guidance on what doctors can and cannot do, particularly as new pathways are brought in, and perhaps that guidance will be prayed in aid before the courts. The whole situation is completely unclear, unsatisfactory and, frankly, hypocritical. Nobody takes it seriously.
	The law should not be made by the back door by the Director of Public Prosecutions. On a matter of fundamental principle it should not even be made by judges under jurisprudence. It certainly should not be made by professional associations producing guidance for their members. That is a completely disreputable way of producing the law. We in Parliament have abdicated our responsibility to ensure that we have a law that is clear, can be respected and can therefore be upheld. We must no longer abdicate this vital responsibility.

Baroness Nicholson of Winterbourne: My Lords, I serve as a Member of this Chamber in the Parliamentary Assembly of the Council of Europe. It is in that
	context that I wish to draw noble Lords’ attention to the Council of Europe’s banning of euthanasia on 25 January 2012. As your Lordships of course know, Britain was one of the founder members of the Council of Europe and, in May 1990, we assisted through the treaty of London in forming the European Convention on Human Rights. Although that convention was misinterpreted when it was it put into law by the previous Labour Government, with Articles 6 and 8 distorted, we are none the less committed to it and continue to support it fully as a nation.
	Nearly two years ago, on 25 January 2012, the Parliamentary Assembly of the Council of Europe adopted a resolution stating:
	“Euthanasia … must always be prohibited”.
	This articulates a strong principle for life and against euthanasia, given that, for the very first time, euthanasia was so clearly rejected by a major European political institution.
	This was a third major victory for life and dignity of the weakest after the 2010 resolution of the Parliamentary Assembly that strengthened freedom of conscience for doctors and medical staff, and after the European Court of Human Rights asserted in 2011 that there was no right to euthanasia or assisted suicide under the European convention. The Council of Europe resolution, passed in January 2012, states in Article 5:
	“Euthanasia, in the sense of the intentional killing by act or omission of a dependent human being for his or her alleged benefit, must always be prohibited”.
	The resolution is entitled:
	“Protecting human rights and dignity by taking into account previously expressed wishes of patients”,
	and aims for a clarification of the principles that should govern the practice of “living wills” or “advance directives” in Europe. Patients should be permitted and encouraged to express in advance their wishes with regards to medical intervention and treatment in case a situation occurs in which they are no longer capable of doing so.
	Given that divergent regulation in European countries and the abuse of so-called “living wills” or “advance directives” can provide a gateway for euthanasia or assisted suicide, there are growing concerns about the effective protection of human dignity at the end of life. Therefore, the Parliamentary Assembly judged it necessary to present clear guidelines to close the door to euthanasia, to the abuse of “living wills” and to surrogate decisions by recalling principles elaborated in previous documents such as the Oviedo Convention on Human Rights and Biomedicine. First and foremost, the Assembly sets the principle that,
	“intentional killing … must always be prohibited”.
	Secondly, an important amendment introduced by an Italian Member of the European Parliament, Luca Volontè, was adopted, so that Paragraph 7.8 states that,
	“surrogate decisions that rely on general value judgements present in society should not be admissible and, in case of doubt, the decision must always be pro-life and the prolongation of life”.
	With the adoption of this resolution, the Council of Europe placed the ball in the court of countries that permit euthanasia, such as the Netherlands and Belgium.
	Even if this resolution is not legally binding, these member states are expected to be aware of the standard set forth by the Parliamentary Assembly and to review their own legislation.
	That draws my attention to the words of the noble Lord, Lord Joffe, in 2004, who said that his Assisted Dying for the Terminally Ill Bill was just a “first stage”. The slippery slope opens up there. In the Netherlands, euthanasia is permitted for children who are 12 years old; in Belgium the age is coming down to 12. Let us think of the burden that this would place on National Health Service, with at least 11,500 to 12,000 deaths being assisted, the mass of prohibitions that would surround that, the amount of debates and the enormity of transforming our National Health Service perhaps into a national death service. I strongly oppose.

Baroness Meacher: My Lords, I, too, applaud the noble Lord, Lord Dubs, for moving today’s Motion. I strongly support his position that every individual should have the right to decide how much suffering they must bear. Of course, we acknowledge that right for those who want to continue until the end point and take any suffering that life throws at them. We just ask for the same right for those of us who wish to take advantage of it. Patient autonomy is a well established principle in medical ethics, enshrined in professional guidance. How can we justify removing the right of choice—the autonomy—at the end of life when people most need it? I simply do not understand that. To respond to the noble Baroness, Lady Nicholson, we are not here talking about euthanasia, yet most of her contribution was devoted to that.
	I shall not repeat the very eloquent points made by many noble Lords but will instead focus my comments on two other end-of-life issues, particularly the right of choice. One is the right not to be resuscitated when life has become unbearable and the second is the right to decide where we die. When a person has capacity, there is no excuse at all for not doing what they wish. Yet, routinely, patients are resuscitated against their wishes and do not die in the place of their choice. The Mental Capacity Act 2005 created advance directives that should ensure that patients’ wishes are known and followed should they lose capacity. However, even when a patient completes an advance directive and a copy is included in their medical records, too often it proves useless because we do not have in place procedures that ensure as far as possible that emergency services and hospital staff know that an advance directive exists, let alone what it says. We need a national policy that governs exactly how and where advance directives are documented. It sounds a trivial point, yet there is really no use in having a document hidden away in some GP’s surgery when the ambulance men turn up and have to make decisions.
	One suggestion is a register of advance directives similar to the organ donor register. Of course, it should be electronic for easy access. That would greatly increase the likelihood that emergency services have the information they need when they need it. Will the Minister consider whether NICE should publish guidance
	on the detail of these advance directive procedures, such as how they should be recorded and stored, and what procedures the emergency services should follow to make sure that they access that crucial information? I understand that, shortly, electronic medical records should include advance directives. Again, these must be user-friendly and accessible quickly. Will ambulance men have access quickly to that information? Also, will the Minister propose to the CQC that it gives priority to inspecting these procedures? In mental health services, the CQC gives terrific focus and priority to how documentation is preserved, kept and stored in relation to detentions in hospital. If the CQC gave anything like that priority to advance directives, the care of elderly people towards the end of life could be radically enhanced.
	Now I turn to the issue of where patients die—I will do this rather quickly. The issues are raised very clearly in the Macmillan Cancer Support briefing. The fact is that 73% of cancer patients want to die at home but only 29% are able to do so. There are all sorts of reasons for this, such as a lack of free social care at the end of life. Can the Minister say a little about that? There is also the lack of 24/7 care, most particularly nursing care. Again, what does NHS England plan to do about that? Thirdly, there is the need for the early identification of people at the end of life. Is the Minister able to provide some statistics about the projected numbers of domiciliary nurses available over the next five years relative to last year? I hope that the Minister can provide some reassurance to this House.

Lord Rowe-Beddoe: My Lords, I, too, thank the noble Lord, Lord Dubs, for providing us with the opportunity to debate this topic. It is being proposed that the law should be changed to allow assisted suicide. This presupposes that there is agreement that the law as it stands is not adequate. What is being referred to by some noble Lords today would represent a major change to the criminal law. Parliament is being asked to agree that some people, namely doctors, should be licensed by law to involve themselves in deliberately bringing about the death of some others, namely people who are terminally ill. This, I propose, is no small adjustment; it is a major change of the law.
	I suggest that if your Lordships’ House is to consider such a proposal seriously, it needs hard evidence that currently the law is not fit for purpose and if that is so, that which would be put in its place would be better and, above all, safer for us all. I do not believe that such evidence has been produced. All we hear are some honeyed words about the need to reduce suffering and some ill informed claims of what the law says and how it works.
	For example, we are told that the law does not provide certainty as to whether a person who assists a suicide would be prosecuted. As citizens, we most certainly have the right to know what the law is. I submit that we do know. The law is clear: encouraging or assisting another person’s suicide is a criminal offence. Discretion is provided to the Director of Public Prosecutions to decide whether a prosecution is
	needed in the individual circumstances of any case. There is a published prosecution policy setting out how such decisions are reached and providing some of the circumstances which might incline the DPP to prosecute, or not to prosecute. This, however, is not sufficient for those who wish to see assisted suicide licensed by law.
	A major complaint is that someone who breaks the law and assists a suicide does not have certainty as to whether the offence will be prosecuted. Certainty cannot be given as the outcome of a breach of the law will depend on the circumstances in which it was committed. To give assurance that a prosecution for assisted suicide would be in this or that circumstance would clearly amount to changing the law. Further, we are encouraged to believe that the law is cruel because of the maximum penalty that it holds in reserve— some 14 years. But no sooner do we work ourselves up on this issue than we are told that the law is not working properly because those who break it are not being prosecuted.
	The reality, when the spin and fog is cleared away, is that we see a law with a stern face and an understanding heart. The penalties which the law holds in reserve are, I suggest, sufficient to make anyone minded to assist another person’s suicide think very carefully before proceeding. As a result, the offence is rare and the few cases that reach the DPP tend to be those where there has been serious soul-searching and genuinely compassionate assistance, perhaps somewhat reluctantly given. In such cases, the DPP is able to exercise the discretion that the law provides. I suggest that before there can be serious discussion of how the law should be changed by Parliament, we need clear and convincing evidence that it should be changed and that what would be put in its place would be better and safer—safer, that is, for us all. Until that evidence is submitted, we should return these proposals to the drawing board.

Lord Blair of Boughton: My Lords, I should declare an interest in that, along with the noble Baroness, Lady Murphy, I served on the commission of the noble and learned Lord, Lord Falconer. My contribution to today’s debate will be to consider some of the practicalities of the current situation and their appalling effect on individuals.
	One of the main aspects of the Bill introduced by the noble and learned Lord, Lord Falconer, as the noble Lord, Lord Rowe-Beddoe, has just described, would be to seek to alter the legal framework concerning assisted dying, which it found to be unfit for purpose. As has just been said, while 14 years’ imprisonment is the penalty, no one has been prosecuted for many years. Furthermore, the previous DPP issued guidance that makes it unlikely that any non-medical person assisting another to die with no malicious reason would be prosecuted. So what is the problem and why is it unfit for purpose?
	I suppose I was asked to be on the commission so that I could help it with investigative and prosecutorial experience. Actually, I did not need to because the witnesses did that. As the law sees assisted dying as a criminal act, and because such an act has no regulation, then when such a process takes place the police inevitably
	have to be involved. I do not think that anyone quite understands what that means. If an assisted death has taken place and the police arrive, they will deal with that as a potential homicide scene. They will photograph it, isolate it and seize notes left for relatives, gifts and computers. Those involved are under the threat of arrest, are interviewed under criminal caution and will face months of waiting for a prosecutorial decision, and it may not be possible even to have a funeral very quickly. However kind and professional the police are, how much more pain do we want to inflict on people who have done what they believe to be right, out of compassion?
	I shall tell noble Lords just how much more pain. One witness spoke of his wife, who had been diagnosed with motor neurone disease. She was a nurse so she knew what the disease would do. She was determined to die before she was unable to take her own life. She told her family that but she would not ever tell them when and where she would do so, which meant, as the witness said, that the love of his life died alone with no one, particularly him, to hold her hand while she was dying. If that was not enough, it did not work, of course, because the police came in and investigated her death anyway since that is what they have to do.
	That is the practicality of a law that is wrong, which is protected only by prosecutorial guidance that can be changed, and which leaves the police inevitably to have to perform an immensely distasteful process for people who are already suffering enough. We should remember the wise advice of the friends of the noble Lord, Lord Dubs.

The Earl of Glasgow: My Lords, I made a speech a week ago in support of the legalisation of assisted dying, and I do not wish to bore your Lordships by repeating the same arguments all over again—many of which, by the way, have been made very well by noble Lords today.
	However, I want to emphasise a point that is misunderstood by many of those who oppose assisted dying: the change in the law that we are proposing would apply to only a very small number of people in very specific circumstances. It has nothing to do with euthanasia or helping or encouraging people to die prematurely unless they have specifically and unambiguously requested it. It certainly would not apply to elderly people suffering from some form of dementia. Yet some of our opponents appear convinced that assisting dying is just the thin end of the wedge, the slippery slope that will eventually lead to helpless old people being quietly put to sleep. No; as many noble Lords have already said, this is first and foremost about individual choice, a choice that we may all have to make when we learn that we are dying and have only a short time to live.
	In the vast majority of cases, nature will take its course and we will be fortunate enough to die peacefully in our sleep with the minimum of pain near our end. However, a minority of us will contract a terminal disease or illness where we will face the inevitable prospect of several months of severe pain and indignity, even with the best medical treatment. Some of us will
	seek palliative care while some will choose to fight through to the end, but others would like the option of being able to die in their own homes on their own terms at some time before the scheduled time of their death. To achieve that, though, they will almost certainly need assistance, particularly from a doctor or medical practitioner. As the law stands now, they are denied that help. Consequently, they are denied that choice and sometimes feel desperate enough to travel at considerable cost so that they can spend their last hours in an impersonal clinic in Switzerland.
	Why should the law in this country deny them that choice, to die in their own home with their family around them, because of fears of slippery slopes or the second coming of Dr Shipman? This choice would be taken up by only a small but significant minority of people. Surely the law should allow terminally ill patients who are in their right mind to die in the way that they choose. Anything else is nothing less than unnecessary cruelty and a denial of human rights. The choice—I repeat that it is only the individual’s personal choice that I am talking about—of being able to avail oneself of assisted dying should surely be a great comfort to all of us, and certainly not a threat.

Lord Hylton: My Lords, today’s debate seems to be a dress rehearsal for the Second Reading of the Bill of the noble and learned Lord, Lord Falconer. However, I start from antiquity, where suicide was normal if someone suffered disgrace or their honour was seriously impugned. The Japanese samurai had a somewhat similar view. For the Jews, suicide largely fell under the command, “Thou shalt not kill”. For the western world, the Christian faith changed the earlier ways of thought. Shakespeare summed it up and gave a strong pro-life view in Act I of “Hamlet”:
	“Or that the Everlasting had not fixedHis canon ’gainst self-slaughter”.
	Islam is clearly opposed to euthanasia. Buddhists are doubtful about the rightness of suicide, emphasising the principle of not doing harm. Hinduism stresses Ahimsa, which is similar, and believes in Dharma, the accepting of moral duties. All faiths seek to minimise unnecessary suffering. Given the views of the great world religions, I conclude that humanists would be unwise to impose their genuine convictions on everyone else.
	My second point comes from the old saying, “Hard cases make bad law”. We may be harrowed by individual cases of people suffering great pain, longing to die but perhaps too weak to kill themselves. Appeals to our compassion or to the principle of utility, however, should not be allowed to outweigh our duty to the common good of the great majority.
	Changing the existing law would impose unnecessary burdens on a range of people. The handicapped or depressed will ask, “Am I a charge on society? Am I using resources that should be devoted to others? When will I reach the six-month point?”. Carers will wonder, “Should I speak to the declining person while they are still capable of deciding?” Temptations will face the beneficiaries of wills. Young people, perhaps aged 19 or 20, could make valid decisions, thus robbing
	their parents of precious time still together. Doctors and nurses also believe in preserving life rather than ending it. They have, and still seek, to provide a health service, not a death service. We should not add to their burdens but remember their Hippocratic oath.
	I respect the deeply held convictions of those proposing change. Neither side will probably convince the other. Can we at least agree to work for a more co-operative and caring society where more people are enabled to die at home and fewer in the institutional surroundings of hospital wards? I believe that we should aim for all to be accompanied to a natural death in a familiar setting, with loved ones close at hand.

Baroness Murphy: My Lords, there are policy priorities for the end of life and there are legislative priorities. They are very far apart, but intimately connected. I have no doubt that the policy priority must be to improve the experience of dying in hospital, as that is, at the moment, where most people die.
	End-of-life care requires honest conversations between doctors, nurses, patients and families. The antecedents of a bad death are exactly the same as those that engender generally poor care in hospital wards. I admire the report published by the noble Baroness, Lady Neuberger, and her colleagues which looked at how to replace the Liverpool Care Pathway with individual care plans, but I fear it will not make a jot of difference until the culture of medicine and nursing is transformed.
	However, this policy priority is not the legislative priority, and compassion dictates that we find a safer way in legislation to help all dying people, just as in Oregon state the death with dignity law stimulated the public’s understanding of death and dying and increased the provision of good palliative care. I believe that focusing our legislation on the tiny few who want to make their own choice of time of death will not only help the few but will help to create an understanding of the broader needs of dying people.
	Let us imagine for a minute that the Falconer Bill has already been enacted. In the average clinical commissioning group area, we are talking about five or fewer people a year who would make the request and fit the criteria. That figure is derived directly from Oregon state. The noble Lord, Lord Alton, is right in saying that the numbers have gone up slightly in Oregon, but there is no statistically significant increase. It has remained at that tiny figure over the past 15 years, and it looks as if in Washington state, which is double the size of Oregon, it will be the same. There are four years of experience there. Five people annually are enough for a small team of expert doctors to administer a code of practice that would be devised by the professions and laid before Parliament.
	I want to concentrate on just one safeguard because the others are fairly easy to address. It is about what the noble Lord, Lord Tebbit, in a debate in Grand Committee so memorably referred to recently as “the vultures”—relatives who cannot wait to get their hands on an inheritance—and those who might exert subtle pressures on people to kill themselves. This has already been mentioned by the noble Lord, Lord Hylton, and
	has been mentioned in the past by the noble Lord, Lord Tombs, and the noble Baronesses, Lady O’Neill, Lady Campbell and Lady Grey-Thompson. I spent many years as an academic psychiatrist doing much testamentary capacity expert witness work and, believe me, I know that the vultures are circling overhead. It is crucial that we can spot where there are profound or subtle pressures on individuals. But given that all those seeking an assisted death will have full mental capacity, how susceptible are they really? We do not need to guess or to create false scares. A research review has recently been published by the American Bar Association Commission on Law and Ageing. Almost all those who are subject to undue influence or subtle pressures are indeed suffering from lack of mental capacity, as you would expect. They are very aged, frail and have dementia. They are habitually exploited. The very few who are subject to undue influence when they have full capacity are in those very curious situations, which are fairly easy to detect, where one individual is very dependent on another. We saw that recently in the case where a group of people were subject to imprisonment. I would refer to it as emotional imprisonment. They are very rare cases indeed. We can take account of them. A humane society that really cares for individuals should be able to meet the wishes of that tiny few who want to say where and how they die, with whom they die and also when.

Lord McColl of Dulwich: My Lords, if it was possible to choose the occasion of one’s death by electing to be killed, it would create an escape route at the onset of an illness which, given time, would take away one’s independence and one’s mind. It would be an escape route from the fear of indignity and suffering. I understand that fear only too well. My wife, Jean, died last year having had dementia.
	I have drawn two conclusions from my experience. First, it is imperative that we care for those who are suffering in this way and that we treat them with dignity. We need to create a society in which such care and treatment is the norm. I am so grateful to those of your Lordships and, especially, the doorkeepers and security officers who treated Jean with dignity and extended many kindnesses to her. It is so important to invest our time and resources to ensure that dementia patients receive proper care. Secondly, dependence is natural at certain stages in life. All of us were dependent on others at birth and for a considerable time thereafter. Dying is part of living and during that time we may be dependent on others. Why should that be a fearful thing? It is probably because our society prizes independence and schools us into it at an early age. We need to revisit this and to be educated to appreciate that dependence is no cause for shame.
	The choice that I would like people to be able to make at the end of life is a choice to go on living in the assurance that they will be cared for with compassion and not ignored or regarded as a burden. All sides of this debate recognise that if assisted suicide is to be legal, there must be safeguards. Many of us believe that it is not possible to legislate for adequate safeguards.
	That aside, it is pertinent to ask whom the safeguards are intended to protect. It is sometimes assumed that it is only the would-be suicide who needs protection. Indeed, he or she does need protection, but society as a whole is also in need of protection from changes in the law which may have a deleterious effect.
	There is a danger of confusing the role of the health professional and undermining the trust which exists between doctor and patient. At present, the health carer’s mandate is crystal clear. It is always to care and never to kill or assist in killing. One cures by treating the patient and eliminating the disease. Eliminating the patient is not treatment, no matter what the patient may request. Where one cannot cure, society should provide care. At present, the provision of adequate care is patchy and uncertain, and this needs to be addressed urgently.
	If one was to legalise assisted suicide, one would be setting up independence as a quality whose worth is greater than life itself. What would such a society be saying to disabled people and the mentally ill? As the New York State Task Force on Life and the Law reported:
	“The legalization of assisted suicide would itself send a message that suicide is a socially acceptable response to terminal or incurable disease. Some patients are likely to feel pressured to take this option, particularly those who feel obligated to relieve their loved ones of the burden of care. Those patients who do not want to commit suicide may feel obligated to justify their decision to continue living”.
	While those who champion the legalisation of assisted suicide do so, I am sure, with the best of motives, I believe it to be a profound mistake. For these reasons and others, which time does not permit me to address, I believe that our energies and resources are best spent on improving the care that is available so that people can choose to go on living with confidence that they will not be neglected.

Baroness Hollins: My Lords, as the immediate past president of the BMA and chair of the BMA Board of Science, I remind your Lordships’ House that the BMA opposes all forms of assisted dying and believes that ongoing improvements in palliative care allow patients to die with dignity. The BMA respects the concept of individual autonomy and encourages patient choice about clinically appropriate treatments, but it believes there are limits to what people should be allowed to choose when their choice impacts on other people.
	The Department of Health end-of-life care strategy says that more people are making choices about their care and treatment, but that too few health professionals yet know how to talk about death and dying. Can the Minister say what is being done about this? There is clearly still plenty of room for improvement.
	Despite that, we can be rightly proud of our pioneering work to create and develop the specialty of palliative care. We are ahead of the curve, leading the global race. Dame Cecily Saunders, the founder of palliative medicine, left us an extraordinary legacy. As suggested by my noble friend Lord Alton, I agree that her legacy could be undone by the introduction of assisted suicide
	as a choice. Without strong advocacy, constraints on NHS funding could lead to more cuts being made to end-of-life care. Assisted suicide, instead of being an option, would be the cheaper alternative. We would be offered either/or—rather as in Oregon, where patients have to sign out of active treatment to access hospice support and where palliative care is not a clinical specialty. Since our healthcare system is more similar to that of the Netherlands than that of the USA, we should be studying practice there, with one in 34 deaths now being through euthanasia.
	It could be argued that it would make economic sense both for families and for the nation. However, this is a policy change that would replace our traditional commitment and compassion to each other—“in sickness and in health”—with a greater value being placed on high-achieving, fit and healthy members of our communities. Instead, we could invest more in our pioneering palliative care services and sell them abroad. We could train overseas doctors and nurses. We could accelerate our search for a cure for dementia and other long-term conditions. Now that we have legally recognised parity between physical and mental health, we could become the most psychologically aware nation in the world, and bring our new learning about their interrelatedness to our understanding of death and dying, rather than continuing to deny it. Let us use our emotional intelligence here.
	In response to the question of the noble Lord, Lord Joffe, it is usually unfinished business with family and friends that causes someone’s unbearable suffering, both mental and physical. People who have expressed a wish to die are now being publicly encouraged to commit to such a view to support the campaign by Dignity in Dying—which of course formerly had “euthanasia” in its title.
	Certainty is difficult to commit to until you have the experience. Deciding is a process that unfolds and human beings have an extraordinary capacity to adapt. Help the Hospices told the Select Committee that informed choice means experience of palliative care, not just information about it. Let us show the world that our palliative care services put us ahead, not behind, those—only seven—jurisdictions which have chosen a cheap and unwise solution to the problem of death and dying and dependency.
	The focus in the debate today has been more on a timetable for dying rather than coming to terms with leaving this life and what that will mean for the dying person and those left behind. Healthy adults are emotionally interdependent upon one another, and if we had time I would draw on psychoanalytic literature. Suffice it to say, the real issues at the end of life are the care and compassion that comes from being in a relationship with other people, including receiving more than giving, including becoming more dependent. I am talking about the love that endures rather than any physical inconvenience.
	Emotional angst about unfinished business is better worked through than avoided through the mistakenly perceived control that comes with suicide. Dealing with unfinished business allows someone to let go of life and let go of suffering. Dealing with unfinished
	business is also better for those left behind, who will then live more peaceably when their loved one has gone.

Baroness Flather: My Lords, I have spoken on this issue on every possible occasion. The first time I spoke, I mentioned that if my husband, who is very disabled, were in great pain and did not want to go on living, I would help him regardless of what the law would do to me, because I love him. A lot of us who love people—those who are close to us and suffering—cannot bear it; as much as the person cannot bear it, we cannot. I think the DPP will now say that that is all right. That is a move forward. Fortunately, however, my husband is not in pain and is doing everything, so that is all right. However, he got two e-mails saying, “Watch out for that woman” on that occasion.
	I remind noble Lords that, when the noble Lord, Lord Joffe, first brought his Bill forward, one noble Lord likened it to Nazi practices. I have never forgotten that, and I hope that nobody will ever think of it like that.
	It is a matter of choice. It is about us being given a choice, not compulsion. Nobody is going to be compelled to take their life in their own hands. The noble and learned Lord, Lord Brown, put it so well when he said that we have moved on in all sorts of ways, legally. We do not have capital punishment, and many other changes have come about. Everybody talks about the slippery slope—thank goodness for the slippery slope, otherwise we would still be sitting in caves. We always need to move forward. Perhaps we should not have invented the wheel. It is important for us to look to the future.
	Abortion has been mentioned as if we suddenly discovered it and therefore introduced a law. No, we did not suddenly discover abortion; it has been with us since the dawn of time. Women have suffered since the dawn of time. What we did was to save their lives. Many women cannot manage to bring up a child. Many women do not want that child. Well, it is not worth that child who is not wanted coming into this world.
	We have to think about things which have been and are going on, and provide for them. It is no use saying that we have discovered this or that and are therefore doing it. These things have been with us for a long time. Medical science has practically made it impossible for us to die quietly and peacefully. We get taken into hospital. We are treated and given antibiotics. The case of Bland led to a commission on euthanasia. It is important for us now to think about our choice. It is extremely selfish of those who are against assisted dying to deprive the rest of us. The right reverend Prelate the Bishop of Chester mentioned that and said that he thought of it as a matter of conscience: if he was against it, should he tell other people that they should be against it? It should and is meant to be a personal choice, and applies only when people have the mental capacity to make it.
	That brings me to another point. I feel very sad that the disability lobby feels that they are vulnerable. They, too, will be able to ask for it only if they have the
	mental capacity to do so. Not only that, they can appoint an LPA to help them make the end-of-life decisions if they need someone they trust. We have a lot of choices in the Bill. I hope that we will think about it carefully, for the sake of those who want it. Care at the end of life will never be sufficient. The Bill would actually make end-of-life care more valuable and give it impetus.

Lord Harries of Pentregarth: My Lords, patient choice is a very great good and we ought to do all we can to encourage and enhance it. There are various ways in which we can do that. First, we can make it much more widely known that there is no moral obligation to go on receiving burdensome treatment when it is doing no good. There is no moral obligation to prolong life at all costs. That has always been the fundamental teaching of both the Roman Catholic Church and the Anglican Church. It is part of our culture and is quite properly reflected in all medical ethical codes.
	I was very glad that the right reverend Prelate the Bishop of Sheffield, whom we congratulate on his maiden speech, spoke about the Liverpool care pathway. I myself was very privileged to be on the commission chaired by the noble Baroness, Lady Neuberger, and I examined very carefully the principles on which the Liverpool care pathway was set up, coming to the conclusion that they were fundamentally sound. The Liverpool care pathway was set up with good intentions, but it became bureaucratic and was not always administered well. I very much hope that our recommendations for the future, from pathway to personal care, will set good palliative care firmly in place in all our hospitals, not just in hospices.
	There is another way in which personal choice can be enhanced and encouraged: by encouraging more people to sign up for advance directives. I know of somebody who is developing an interactive website to help people do that.
	Patient choice is, therefore, a very great good. However, sometimes other goods override the good of patient choice. I will put before your Lordships three very simple and straightforward examples. First, a teenager in great despair pleads with you to help them end their life. Quite properly you override their choice because there is a greater good: the long-term well-being of that teenager. Somebody who is deeply depressed, who should be in a psychiatric hospital, resists going. They have to be sectioned, and sometimes drugs have to be administered to them so that they can be forcibly put into their hospital. Their choice is, quite properly, overridden. If a prisoner is in danger of suicide, they are put under “suicide watch”—a very careful watch has to be kept on them so that they do not commit suicide. Finally, the Samaritans organisation has saved hundreds of thousands of people.
	I suggest by those examples that although patient choice is a good, it is not the only good, and that sometimes there is an overriding good. Those examples indicate that our society values human life at all times and in all circumstances. The noble Lord, Lord Taverne, said that the present law and DPP guidance are a mess
	and have been brought into disrepute. However, I suggest that where you have a very difficult situation, between lives that are unbearable and society’s desire to convey the message that lives at all times—even at the end of life—are of value, you are bound to get some kind of compromise like that. The DPP compromise is workable. It expresses society’s view that everybody’s life, even in extremis, is of value. The noble Lord, Lord Alton, quoted the words of Dame Cicely Saunders:
	“You matter because you are you, and you matter to the end of your life”.
	By having the law—which does express moral values —in place, that conveys society’s high estimate of every single human life.

Lord Judd: My Lords, I thank my noble friend Lord Dubs, not only for giving us the opportunity to debate this subject, but for the very sensitive and objective way in which he introduced the debate this afternoon.
	Surely it is important, wherever possible, to encourage people to consider their choices of treatment in good time, and for them to have the fullest possible information on which to make well considered choices. If possible, there should always be the opportunity for them to change course.
	To believe in human rights must mean the right to control one’s own life for as long as that is possible. That must include the right to seek release from intolerable suffering—not only for yourself but for those around you. Sometimes, sadly, it is just not possible for a person to communicate their wishes, which places a huge responsibility on others who are involved.
	Some people of my own faith take an inflexible and absolutist position on this, but there will never be an escape from the responsibility of applying love, understanding and compassion in all that is decided. It is never a matter of just clinically managing a decision on the end of life: there are the real issues of direct, indirect or supposed pressure, and it is always a matter of profound consideration of the individual as an individual. The input, if possible, of those who have known the patient for a long time will be a crucial part of this. The physicians should include, wherever possible, a doctor who has cared for the person concerned for a long time.
	Meanwhile, how much of a priority is invariably being given in all training—not least of doctors—to end-of-life care? With increasing longevity and ever-growing survival prospects, dealing with the terminally ill and dying leads to a constantly greater demand on medical professionals and takes up an increasingly important part of their professional lives.
	It is absolutely clear that the majority of people do not want to die in hospital, and seek the psychological or emotional security of home or a hospice. What I have experienced from my own involvement as the president of Hospice at Home West Cumbria is that that concept of a hospice at home can be a very valuable available choice. It brings together a community of professionals and volunteers. While the volunteers seek to achieve professional standards in all that they contribute, the professionals are really volunteers
	themselves in bringing a quality of commitment which is way beyond what could be expected from a contract. At its best, there is a culture of teamwork and mutual support. Volunteers can have a sensitive and effective part to play in family support and bereavement counselling. Strengthening all this is the accessibility of what the hospice offers, very much on a socially inclusive basis, and the widespread feeling in west Cumbria that it is “their” hospice to which they have a responsibility, not least in fundraising. I am convinced that this broad base contributes to a reassuring sense of belonging among patients and families alike.
	What is essential is a close, flexible and imaginative working relationship between the hospice and the NHS—a context of mutual support, recognised interdependence While the hospice can ease the pressures on the NHS, the latter is indispensible to ensuring, for example, support for specialist services, particularly palliative care and pain relief.
	It is very significant, when we are looking at the future of health services in our countries, to see the relevance of that kind of initiative. I hope that the Government take it seriously, and that they can play their part in making sure that the necessary resources are available.

Lord Singh of Wimbledon: My Lords, this debate takes us into new ethical territory with complex medical, legal and emotional implications. Rational discussion is made more difficult by a polarisation of attitudes and opinions. I saw something of this about 12 months ago when I attended a meeting of the All-Party Parliamentary Group on Assisted Dying. I raised some concerns and was made to feel that there was something wrong with my thinking if I could not immediately see the open-and-shut case for changing the existing law. I am also too aware of the opposite arguments, couched in religious terms, that life is a gift from God and we should never, ever, even think of curtailing it.
	I served for some years as a member of the BMA Medical Ethics Committee and am well aware of major changes in society and bewildering advances in science and medicine that require us to constantly look anew at previously accepted views and attitudes. Sikhs accept that life is a gift of God to be cherished and preserved wherever possible, but we are also required to bear in mind the important Sikh teaching of compassion, dignity and care for the suffering. These two considerations are not necessarily incompatible. However, I am unhappy about a narrow focusing on individual autonomy to justify attitudes that clearly affect others. We have seen some of this today. We constantly hear the argument that we are all individuals and that our happiness and needs are all-important to the exclusion of our responsibility to others. I believe that this over-focusing on self, on me and my, is responsible for many of the ills in society today. For example, we are all aware that religious teachings suggest that marriage is a committed partnership for mutual care and support and for ensuring that children grow up as responsible adults. What I believe to be a short-sighted contemporary social attitude encourages
	us to believe that it is okay to look exclusively at our rights, without consideration of the effect on others. This focusing on individual needs rather than on the family as a whole is, at least in part, responsible for the growing increase in dysfunctional families, with children frequently ending up in what we euphemistically call care, or with them mirroring the narrow thinking of their parents. A person’s decision to end their own life has an effect on friends and, importantly, on the message it can give to wider society of trivialising life. We all have wider responsibilities in all that we do.
	I shall pull together these different threads in rational and compassionate decision-making to arrive at the way forward. First, we should always respect the gift of life and question the concept of autonomy. Secondly, there are times when those in ill health feel that life is not really worth living but, within a short time, they often feel that it is not really that bad. It is worse for those who find themselves with severe disabilities but, as the Paralympics showed, despite such disabilities, it is often possible to live a meaningful life. Relatives and carers sometimes find looking after someone onerous, and they can inadvertently make their feelings known to those they are caring for, making them feel an unnecessary burden. Sadly, there are others who may have more mercenary motives. A seemingly hopeless situation today may not always remain so. Huge strides are constantly being made in combating previously incurable diseases, as well as in palliative care.
	In summary, while we should always be on our guard against the notion of individual autonomy trivialising life, we need to recognise that, from an individual’s perspective, life can become pretty intolerable and there is an argument for helping to end it in strictly controlled circumstances. The danger is that, if we go down this path, it could itself be a slippery slope to trivialising life, altering the very ethos on which medical care is provided. I feel, on balance, that we should leave the law as it is.

Baroness Warnock: My Lords, I congratulate the noble Lord, Lord Dubs, on introducing this debate, which is timely on two counts. First, we have a chance to think about the demise of the Liverpool care pathway, which was obviously well intentioned but had flaws. We have not yet had a chance to consider in detail what should be put in its place, if anything. Secondly, as this debate has shown, it is a kind of run-up to the debate that will take place later next year on the Bill proposed by the noble and learned Lord, Lord Falconer. I do not want to say anything more about that Bill except that I agree very strongly with the view that the present state of the law is unsafe and intolerable and cannot be supported.
	I go on to one issue that seems something of a scandal—the case of patients who are dying who may actually be, or may be perceived to be, incompetent to make decisions about their treatment. I cannot think of anything more humiliating than to say that I wanted to die and that my life was no longer worth living only to be told that I was suffering from depression. Well, I would be suffering from depression in the ordinary
	sense of the word—but I could be told that I was suffering from clinical depression and could be cured by medication. My lawful refusal of medication might even be disregarded in those circumstances, because I should be deemed not competent to make it.
	I regard it as a scandal that so very few people draw up advance directives or put in place a lasting power of attorney. Since the passing of the Mental Capacity Act 2005, this is something that is worth doing and which preserves choice, even in the case of the person being incompetent. One difficulty that has already been mentioned is the difficulty of access to an advance directive, even if it has been made. This is very serious. I have a friend who was involved in trying to devise a bracelet that people could wear to say that they had made an advance directive and how it could be accessed by people in the ambulance service. She was refused hospital help in devising this bracelet because the authorities said that they would be liable to prosecution as assisting suicide if they were known to have helped to devise this bracelet. That seems bizarre, because it would be a help if, as one can carry a donor card, one could also carry some kind of indication that an advance directive existed.
	A worse difficulty is that so few people know about what their rights actually are under mental capacity law, and that many even do not know that there are such things as advance directives or that a power of attorney can be given. The culprits here are general practitioners, who should have a duty to have in their surgery accessible information about advance directives, in the way that they have dozens of leaflets about diabetes, asthma and other kinds of ills that people may suffer. This seems to be something that would be very easy to do—and then people, whatever their age or state of health, who came to the surgery, would have access to the means of making an advance directive. The means could be made simpler; the doctor could sign the pro forma that could be supplied in the surgery. People could, almost as a matter of routine, ensure that they had such a thing in place if they feared that their treatment at the end of life would be not what they would want and not what would be best for their own interests and the interests of society.
	This is a very important change that ought to be made, and which could be made, if only the medical profession was not so very much afraid of death. This is a terrible indictment, really. Even at my age, I frequently talk to my GP, who I know well, about death—and he to me. But that is very rare. On the whole, doctors need, most of all, to change their attitude to death, because their professional and compassionate duty is not always to save life but to relieve the suffering of their patients. I think that this is a change that we can make.

Baroness Masham of Ilton: My Lords, I thank the noble Lord, Lord Dubs, for giving us the chance to discuss the final moments of life. End of life comes in so many ways; very often there is not the opportunity to have a choice. I was so pleased that Nelson Mandela, a remarkable person who had been ill with a chest infection and treated in hospital, went home, with
	medical help, and was able to die with his family around him. Seventy-three per cent of cancer patients would prefer to die in their own homes. However, only 29% of people with cancer are able to do so. Macmillan estimates that, in 2012, 36,000 cancer patients died in hospital who would have preferred to die at home.
	My husband, who would have liked to die at home, died in an A&E department on a Sunday because the out-of-hours doctors would not come out on the Saturday and Sunday. On the Friday evening, when he became ill with a chest infection, which was serious as he had many medical conditions, the out-of-hours doctor came and prescribed a liquid antibiotic as my husband had a swallowing problem. However, I think that she wrote in the notes that he was not too bad. We had to drive for miles to find a supermarket with a pharmacy with the liquid antibiotic. This is the problem with rural healthcare; pharmacies and out-of-hours doctors are miles away. It is much easier to get an out-of-hours vet. With so many medical conditions it would be so much better if the people suffering from them had a copy of their own medical records. My husband died in a hospital 24 miles from home. The doctor could not get any records and had only the information that I could give him. My husband died in the presence of myself, a doctor and a very helpful and kind charge nurse. As it was classed as a sudden death, one had to wait for the police. The chaplain was late. So many people have a real fear that if a loved one goes into hospital they will be neglected.
	During this year a young cousin of mine, aged seven, died of neuroblastoma after a two-year amazing battle with this aggressive childhood cancer. His parents did everything possible, including having him treated in America. He had a lovely thanksgiving service at York Minster, with all the children from his class and his headmistress attending. It is good for children to understand that death happens, and so much research is needed to make things better, but there needs to be ongoing support for those who are left behind.
	We need mindfulness and compassion from those who have the responsibility of looking after patients at the end. Care for the dying must get better. Life and death are precious and sacred. Many vulnerable disabled people fear that they will be at risk of other people making decisions about their life and death if there is new legislation. It is dangerous as it could be a very slippery slope.

Lord Low of Dalston: My Lords, I thank the noble Lord, Lord Dubs, for securing this debate, which may aptly serve as something of a curtain-raiser for the debates we will have on the Bill of the noble and learned Lord, Lord Falconer, when it comes to the Floor of the House next year. I particularly commend the measured and dispassionate way in which the noble Lord, Lord Dubs, introduced the debate, and, indeed, the generally restrained temper of the debate as a whole.
	We do not have long, so I will make just a couple of points. The first, picking up on a point that the noble Lord, Lord Dubs, himself made, is that assisted dying and palliative care are often portrayed as antithetical
	to one another; indeed, we have heard echoes of this today. The supporters of assisted dying are depicted as heartless monsters who simply want to bump their relatives off for their money or because they have become a burden, but this is a travesty. Most people would want to see the alleviation of suffering that palliative care can bring exploited to the maximum. It is only when palliative care is inadequate or can do no more that they say an assisted death should not be ruled out as an option. Pace my noble friend Lord Hylton, nothing is being imposed on anybody.
	I certainly do not accept the argument that the desire for an assisted death simply shows that the palliative care is not good enough, and that it would not be necessary if it was. That is one of those arguments that cannot be disproved because, by definition, the care could always be better. The fact is that in practice that is not always the case. In fact, assisted dying goes hand in hand with palliative care. Evidence from Oregon, where assisted dying for terminally ill adults was legalised in 1997, demonstrates that the vast majority of people who are assisted receive palliative care and support. The use of assisted dying legislation is very low and researchers suggest that the reason for this may be the high quality of care provided by Oregon’s hospices. Hospice provision in Oregon now ranks among the best in the country, but its growth has actually gone hand in hand with the legalisation for assisted dying rather than the reverse. Fears of assisted dying impacting negatively on palliative care have not been borne out; in fact, the opposite seems to be true, and assisted dying can act as a catalyst for the improvement of palliative care. But though palliative care may be excellent, there will still be some people who at the end of life seek assistance to die, and they should be allowed to do so.
	My second point is that the views of disabled people are much more diverse than is represented by disability activists. No, that is too mealy-mouthed in an effort to avoid polemic; they are actually the opposite of how they are commonly represented. In a YouGov survey of 1,000 disabled people reported in the Times yesterday, almost 80% said that someone who helps a friend or family member who is terminally ill to die should not face prosecution. Asked what position they thought disability rights groups should take on assisted dying for the terminally ill, just under half said they should remain neutral, and a third that they should support a change in the law. Only 8% said that they should oppose a change in the law.
	I align myself with Tom Shakespeare, himself a disability activist but not at one with the disability movement on this issue, when he says that,
	“calm and evidence-based deliberation is usually more useful to disabled people than extreme rhetoric”.
	He goes on:
	“It seems to me to be inconsistent to support autonomy for disabled people in all matters except the moment and manner of their death”.
	I agree with my noble and right reverend friend Lord Harries that there are occasions when it is right to override a person’s choice, but the decision must depend
	on all the circumstances. In my judgment, a case where a person is terminally ill, in great pain and wants to die is not one of them.

Lord Tombs: My Lords, I begin by apologising for my late arrival by a few minutes. I came rather a long way and the transport was not quite up to scratch.
	I start by saying that I am opposed to assisted dying—as I think is well known—which has monopolised the discussion today, although the debate is rather wider than that and covers other aspects, which I would classify as assisted suicide. I do not think that we should place too much credence on reports of what happens in Oregon. There are good things about the system there and there are bad. One of the more worrying things is the number of fatal doses lying around that country in medicine cabinets, for which there seem to be no clear plans. That is a time bomb waiting to happen.
	I think that the objections to assisted dying in particular, but also to assisted suicide, concern the vulnerability of ill people, old people, disabled people, and all sorts of people who require help—help which selfish people can consider a nuisance. My own experience, which is getting quite long now, is that the law is a very blunt instrument. It is designed as such because it has to be for the majority of people, quite rightly, because it is a societal invention and exists because of society. In doing so, it incorporates, because of pressure groups, so many exceptions or variations that it becomes almost impossible to administer.

Baroness Finlay of Llandaff: My Lords, this has been a double-sided debate. On the one hand, it is about improving services for people in their last months, weeks and days so they have real choices in care—to be home or in a hospice with their symptoms controlled at the medication level they wish, offered any helpful intervention without waiting, with personal care given with respect, time and as they want, and knowing that their family are properly supported.
	On the other hand, some propose a licensing system for doctors to supply lethal drugs to patients to deliberately shorten the lives of those who are thought to be dying. That is totally different to providing pain relief while a person dies of their disease. Seale’s research showed that illegal action by doctors in Britain is rare or non-existent. This is not just about the complexities of an individual choosing to end his or her life. There are ramifications for others. It is a matter of both conscience and public safety. Others are directly involved in the suicide, and by normalising assisting suicide an attitudinal change occurs across society. Currently, doctors have a key role in preventing suicide; now they are being asked to go into reverse and facilitate it.
	I am afraid that Oregon’s figures do not confirm safety but show an almost fivefold increase in the incidence of reported physician-assisted suicide. That would translate, as has been said, to about 1,200 assisted suicides each year in England and Wales. That means that in Oregon since 2008 there has been a 21%
	increase in physician-assisted suicide, from 19 to 24 cases per 10,000 deaths. Compare that with the UK, where currently fewer than 20 cases cross the DPP’s desk. Oregon has no audit system to shed light on what is happening there. The dynamic seems to have changed. The Bill of the noble and learned Lord, Lord Falconer, gives eligibility criteria, not safeguards. It seems to be looser than the Bill proposed by the noble Lord, Lord Joffe. The current proposal has no reporting and audit system to detect abuse. Indeed, in Oregon, it was only research that showed that one in six patients who ended their life by physician-assisted suicide had clinical depression that was undiagnosed and untreated. There are also reports of patients being offered not oncology treatment but physician-assisted suicide.
	The inquiry by the noble Baroness, Lady Neuberger, into the Liverpool care pathway called for research to improve prognostic tools for the last weeks and days of life. We are very bad at prognosis. The Royal College of General Practitioners has said that we can,
	“make reasonably accurate prognoses of death within minutes, hours or a few days. When this stretches to months, then the scope for error can extend into years”.
	People are particularly vulnerable when very ill. On call last weekend, I was acutely aware how each patient hung on my every word and gesture, reading into it how I thought things were going. Behind each question was another. The GMC guidelines are absolutely clear—they enable in-depth discussions with patients about their dying or their fluctuating wish for death, and doctors are not frightened today of talking about death and dying. People fear being a burden on family, society or state, or being disempowered by the scandalous care that hits the headlines. The message that proponents portray is that for some the only way in which you have dignity when dying is by assisted suicide, that suffering is inevitable and pain often uncontrollable. That is deeply misleading and creates a great deal of anxiety.
	Futile treatment is stopped because it is a burden not a benefit, not to bring about death. However, when a patient asks for help to end it all, the doctor can respond by processing the request at face value, which risks sending a subliminal message that the person would be better off dead; but when I ask, “What is making today so difficult?”, and, “What can I do, however small, to improve today?”, I give the message that, “You are worth me working hard for”. I have to redouble efforts, and rethink and reharness resources to meet the patient’s need to give true choice in care to the person.
	A clinician cannot go in two directions at once by striving to improve quality of life and revise and review, while simultaneously booking an appointment for death. Physician-assisted suicide is being placed in the comfort zone of medicine, suggesting to society that it is some kind of therapy. We have heard euphemisms—assisted dying is not really assisted suicide or will not be extended to euthanasia, we have heard. Let us be clear: what is proposed is that Parliament should license an act that is otherwise regarded as criminal. As the Royal College of Physicians has said, a doctor’s duty of care to a patient,
	“does not include being in any way part of their suicide”.

Lord Beecham: My Lords, as the noble Baroness has just reminded us, this debate encompasses two issues. The first is one that has clearly attracted unanimous approval throughout the House: the need to provide care and support for the dying at the end of life and to honour their choice, particularly in relation, for example, to whether they die at home, in hospital or in hospice—matters referred to by the noble Baroness, Lady Murphy. There is clearly agreement that this objective should be fulfilled, and there are ways in which matters can be taken forward from the current position. Compassion in Dying, for example, has recommended that progress be made in dealing with advance decisions, and simplifying the procedure for living wills and lasting powers of attorney. The noble Baroness, Lady Meacher, referred to establishing a register that, again, Compassion in Dying has referred to. There is the issue of training for professionals and much else. I hope that the Government will look at these matters.
	One matter came to my attention yesterday by virtue of an article by Jackie Ashley in the Guardian pointing out that whereas people can get leave from work for various reasons, there is no provision in law for leave for carers of those who are terminally ill. Perhaps the Government could look at that. I am of course not asking the Minister for a response today but it is something that I invite her and colleagues in other relevant departments—BIS and so on—to look at. It could well make a significant contribution.
	The second area with which we are concerned is assisted dying. On this we have had a very balanced debate. I have been keeping a scorecard of those who have spoken in favour and against, and it roughly balances out across your Lordships’ House. I must also say that the debate has been in the highest traditions of this House in terms of thoughtfulness and sensitivity. There are clear issues here—ethical, moral, religious and practical—that need to be addressed. It is not a party issue. There is no official opposition line, and I suspect that there is no official government line. I speak from a personal standpoint.
	However, it is perhaps necessary briefly to rebut three points that have been made by some speakers. The noble Baroness, Lady Morris, said that under the proposals of my noble and learned friend’s Bill doctors would be required to take the life of patients. That is not the case. The Bill specifically deals with self-administered drugs that could end life. The noble Lord, Lord Alton, spoke of the “emasculation” of the hospice system. I see no evidence of that at all. As I shall say later, I have knowledge of the working of the hospice system and I do not think that anyone who might support my noble and learned friend Lord Falconer’s Bill or some version of it would for a moment wish to diminish the effective role of an important part of our health provision. There was a suggestion by the noble Lord, Lord Hylton, that among the major religions Buddhism was clear in its maxim that one should do no harm. That, of course, is also the substance of the Hippocratic oath. However, the question is: what constitutes harm? Is it confined only to causing death? Can it not also be allowing or facilitating the prolongation of suffering? Therefore, the situation is perhaps more nuanced.
	My own position is informed by my personal experience. My wife died five weeks after I was introduced into your Lordships’ House, having suffered from bowel cancer for two years, with secondaries in the liver and lung. It was always a treatable but not curable condition. She was the daughter and sister of doctors. She nursed her mother, who died of cancer, in our home. She was a health visitor, a nurse and a Relate counsellor. From the outset of her illness, she was very clear that, should she suffer considerable pain, she would wish to be helped to end her life. She received wonderful treatment from the National Health Service in Newcastle and from the hospice in which she spent her last few days. Fortunately, she never experienced quite the degree of pain that would have led her to invoke the remedy, which in any event would not have been available to her.
	She lived very fully in those two years. She made a television programme about bowel cancer; she made a DVD about stoma, having undergone a cystostomy; and, with friends, she produced a book about living with cancer. Therefore, she was very conscious of the condition and anxious that people should learn from her experience. However, I know that she would have wished me to express support for the choice that in the end she did not have to make. I suppose that I had the dubious privilege—nevertheless, I felt it to be a privilege—of being with her when she died in the hospice. She had been sedated and was out of pain for those last few days. Of course, not everybody has that opportunity, and there are those who would clearly wish to have the chance to end what can be a very painful experience.
	I have friends who are undergoing precisely these difficulties now. I have a particular friend who has also suffered from cancer, and it is a recurrent condition. Having, again, been treated very well in hospital and in a hospice, she is now having home care and there is great gratitude for that but, frankly, it is a very painful condition—more painful than my wife endured. It is one which my friend wishes could end swiftly, rather than see her pain prolonged, even though she is having wonderful care, with full medical back-up, at home with her family. I have other friends who have undergone very difficult experiences, and there will be many in your Lordships’ House who can testify to that.
	So we have some difficult choices to make. We are not asked to make choices today; we are debating and discussing how policy might evolve in both the areas that have been the subject of this debate. I take the point made earlier that, if you have the means, it is possible to avoid that debate. You can go to Switzerland, as some people have done, and leave the stage, as it were, there under the system that currently prevails. However, a minority of people can take that course and there will not be many, although there will be some, who would prefer the alternative, which my noble and learned friend’s Bill would secure. Of course there are issues of safeguarding and of avoiding people being persuaded to take that course of action, and it would be essential to embody that in any legislation, should we reach that position.
	There are clearly many who would adopt the approach that Dylan Thomas advised in a memorable poem:
	“Do not go gentle into that good night …
	Rage, rage against the dying of the light”.
	For those who do not want to go gentle, whether they want to rage or not, of course we must offer every conceivable support to allow them to do that. However, others would take a different line of poetry. They might take the line from Keats and wish:
	“To cease upon the midnight with no pain”.
	In my view and the view of some of your Lordships, that is a decision which should also be respected, supported and facilitated, but with the very clear proviso that there must be proper safeguards and that nobody should be required to go against their conscience—for example, as a medical practitioner—to administer what would be required to produce that ceasing upon the midnight with no pain.

Baroness Jolly: My Lords, I thank the noble Lord, Lord Dubs, for securing this debate. I fully appreciate his position on this issue, which is clearly personally heart and head-felt. I know that, as a member of the All Party Parliamentary Group on Choice at the End of Life, this is a subject in which he takes a great deal of interest.
	I echo the words of the noble Lord, Lord Beecham. This is a well informed debate, and at times it has been very moving to hear personal stories from Members of your Lordships’ House. With a four-minute time constraint on speeches, noble Lords have focused their thoughts, and that has led to many powerful points being well made. Here, I should like to make special mention of the maiden speech of the right reverend Prelate the Bishop of Sheffield, which was sensitive, thoughtful and thought-provoking. I am sure that he will make a huge contribution to the work of your Lordships’ House.
	This is an important debate on a highly emotive and complex issue. Death affects us all. First, I assure noble Lords that, as a Government, we are committed to improving quality and choice in end-of-life care. Today, many noble Lords have focused on assisted dying. As was highlighted by the noble Lord, Lord Dubs, and others, the Government believe that any change to the law in this emotive and contentious area is an issue of individual conscience and a matter for Parliament to decide rather than one for government policy.
	The Assisted Dying Bill, introduced by the noble and learned Lord, Lord Falconer of Thoroton, seeks to legalise, in England and Wales, assisted suicide for terminally ill, mentally competent adults who are reasonably expected to die within six months and who have been ordinarily resident in England and Wales for at least 12 months. The Government will take a collective view on the noble and learned Lord’s Bill in order to respond to the debate on its specific provisions at, but not before, Second Reading. As things stand, however, no date has been set for the Second Reading of his Bill and today’s debate does not address it.
	My noble friend Lord Taverne raised the question of the DPP’s role in prosecuting offences. Prosecutors must apply the two-stage test set out in the Code for
	Crown Prosecutors in cases of encouraging or assisting suicide and all other offences. The full code test has two stages: the evidential stage and the public interest stage. A case which does not pass the evidential stage must not proceed, no matter how serious or sensitive. Where there is sufficient evidence, prosecutors must then consider whether a prosecution is in the public interest.
	The noble Lord, Lord Davies of Stamford, stated that the DPP has said that he will not prosecute those who encourage or assist suicide. The DPP’s policy is clear that it,
	“does not in any way ‘decriminalise’ the offence of encouraging or assisting suicide”.
	Indeed, it specifically says:
	“Nothing in this policy can be taken to amount to an assurance that a person will be immune from prosecution if he or she does an act that encourages or assists the suicide or the attempted suicide of another person”.

Lord Davies of Stamford: I am grateful to the noble Baroness for giving way. Of course, in a four-minute speech I had to use some shorthand, but my essential point was that it was extremely undesirable in the interests of both the clarity of the law and in how our democracy works to have the law on such an important subject made by the back door—by DPP decisions or even by jurisprudence. Would the Minister like to comment on that remark?

Baroness Jolly: I take the noble Lord’s point. I am not a lawyer but I will certainly write to him to ensure that his point is answered. In a letter to all Members of this House I will make sure that they, too, hear the same response.
	Noble Lords may be aware of the different ways in which to document decisions on end-of-life care. Many of the general public are not. One option is a health and welfare lasting power of attorney. It allows someone to give authorisation to the attorney to make decisions about health and care, including decisions on life-sustaining treatments. Another option is making an advance decision. This enables anyone aged 18 or older who has capacity to make a decision about their future care. They may wish to refuse a particular treatment or intervention in the future when they no longer have the capacity to make their wishes known. It is a way of making plans for the future. It is a legally binding way of being able to refuse a treatment or intervention. An advance decision can be made not to be resuscitated under certain conditions. An advance decision can be made to refuse all life-sustaining care, provided that certain conditions are met. The decision must be witnessed and made in writing. These advance decisions are legal mechanisms to help a person plan their care. Both advance decisions and lasting power of attorney exist in addition to the systems that clinicians use to record patients’ wishes for end-of-life care.
	The noble Lord, Lord Dubs, said that there should be a positive duty to inform a patient of their rights. Healthcare professionals should proactively seek to communicate with their patients and where appropriate, the patients’ families to find out their needs and preferences, and to capture these in an advance care
	plan if the patient so wishes. Healthcare professionals should understand the Mental Capacity Act so that they can inform patients about these rights if the patient is willing. It would be inappropriate to compel healthcare professionals to force such information on people who do not want it.
	The noble Baroness, Lady Meacher, suggested that it would make a lot of sense to ensure that advance decisions are stored so that they could be accessed at the right time. It is important that those making an advance decision should decide how best to record their decision to suit their individual circumstances. There are also practical issues in trying to rely on a central register to record wishes, such as ensuring that it is up to date and accurately reflects current issues and wishes. Even if a register was established and showed that an advance decision was in place, healthcare professionals would still be required to satisfy themselves that it was valid and applicable, and would have to seek information from other healthcare staff and close family to ensure wishes, so a register would not be solely relied on. The noble Baroness, Lady Meacher, also raised the point of whether NICE should issue guidance on the use of advance decisions. NICE is an independent body and anyone can suggest a topic to it through the topic selection procedure. These are then evaluated to decide the topics on which guidance will be developed.
	The noble Baroness, Lady Hollins, asked what is being done about ensuring that we have the right palliative care services. She raised various points, and when I get to the body of my text I will address that subject. All patients should receive high quality and compassionate care in the last days and hours of their lives, and we know that choice is at the heart of this. The noble Baroness, Lady Murphy, highlighted two issues: legislative decisions and policy decisions. I will direct the rest of this speech to policy-related actions and decisions.
	The mandate to the NHS was refreshed in November this year. We highlighted the importance of improving standards of care at the end of people’s lives as a priority for the NHS and an area in which we expect particular progress to be made. In response to a recommendation made by the NHS Future Forum, the Government updated the NHS constitution in March 2013 to make it clear that patients should be fully involved in all discussions and decisions about their health and healthcare, including end-of-life care.
	I now want to set out further details on the work that we have planned for extending choice in end-of-life care. We recognise that dying well means people being able to exercise more choice in where they receive their care, and to have quality services delivered where and when they need them. We know that most people would prefer to be cared for and to die at home, in familiar surroundings, surrounded by friends and family. We know that currently more than 50% of people die in hospital, the place where they would least prefer to be. We want to make sure that services are set up to help people to die at home, with high quality end-of-life care for all those who need it. However, increasing choice is not an easy task that can be done overnight.
	In Liberating the NHS: Greater Choice and Control, we set out our commitment to move towards offering more choice nationally to support preferences on how to have a good death. In light of this, we have been working with the National Council for Palliative Care to undertake a review, of when and how choice could be offered in end-of-life care. Noble Lords will be interested to know that a workshop involving all the key individuals and organisations in end-of-life care will take place early in the new year. It will discuss the key issues and barriers that the review will need to consider. In particular, a review will consider when such choices could feasibly be introduced, with the right services and support in place to deliver this. Our intention is that the review should be as comprehensive as possible, looking at all the issues in depth and involving all key stakeholders. We would therefore encourage and greatly appreciate your Lordships’ input. Any changes requiring legislation would be introduced using existing legislative powers. The outcome of the review will inform NHS England’s future approach to choice in end-of-life care.
	The noble Lord, Lord Dubs, asked when we could expect proposals to replace the Liverpool care pathway. The work on a response to the independent review of the Liverpool care pathway is being led by the Leadership Alliance for the Care of Dying People. The alliance is currently engaging on draft outcomes and guiding principles that would underlie the care of people at the end of life in all settings. The system-wide responses will be published in the first part of 2014 after the engagement concludes. The right reverend Prelate the Bishop of Sheffield asked about the role of chaplaincy services. The College of Health Care Chaplains is represented on the alliance and will be part of the process of developing the final version of the outcomes and guiding principles. I endorse the comments made by the right reverend Prelate on the key role that chaplaincy services can play in end-of-life care.
	Recent survey findings indicate that there is an increasing trend that people wish to die at home, and we cannot ignore that. The End of Life Care Strategy, published by the Department of Health in 2008, set out the ongoing ambition to support more people to die in their preferred location. Work is ongoing from NHS England—the leadership alliance—to refresh the strategy. This refresh will look at the strategy’s recommendations, including on patient choice, and build on them for the future direction of end-of-life care. NHS England is looking to complete this work early in 2014, which will inform its future approach. Following on from this, we know that one of the main barriers to people receiving the care they deserve is a lack of open discussion between health and social care staff. The noble Lord, Lord Dubs, spoke of the death taboo slowly receding, but in some cultures death is still considered part of life itself.
	We know that after speaking to their loved ones about plans for end-of-life care, GPs are next on the list of people that patients most want to talk to. We also know that where GPs initiate conversation, nine out of 10 people are happy to continue with it. However, we recognise that some people would not wish to enter into conversations, either with their family or with
	health and social care staff. If this is their choice, we would expect healthcare staff to respect that.
	All this is the background to the Find Your One Percent campaign. One per cent of people on a GP list will die each year. The purpose of the Find Your One Percent campaign is to help GPs make sure that people who may be approaching the end of their life have the chance to discuss and plan for their end-of-life care. The campaign is hosted by the Dying Matters coalition, working with Macmillan Cancer Support, the Royal College of General Practitioners and others to ensure that clinicians are provided with the information and, more importantly, the resources they need to support a good death.
	The focus is on helping. We believe that GPs play an important role in helping patients to make choices that are right for them and to make sure that this happens. Guidance has been produced for GPs to help patients make informed choices. It is not compulsory for them to follow, nor is it about hitting government targets: it is about improving the quality of people’s experience at the end of life and ensuring that they receive the care they need, when they need it. GPs can help make sure that that happens by offering people the opportunity to prepare an end-of-life care plan. Care planning of this type is not a single event. Plans evolve as people’s conditions change or their preferences alter. This mechanism allows GPs to ensure that people get the treatment they want at the end of their lives, and have a chance to discuss this difficult topic and express their preferences.
	Further, the quality and outcomes framework, a voluntary reward and incentive scheme for GP practices in England, currently has two dedicated indicators for palliative care. The framework encourages GPs to establish and maintain a register of all patients in need of palliative care and to have regular, multi-disciplinary case review meetings where all patients on the palliative care register are discussed. These indicators are being retained in the quality and outcomes framework for 2014-15.
	In October 2013, NICE, the National Institute for Health and Care Excellence, announced that it is shortly to review its quality standard for end-of-life care for adults and the support guide for commissioners. This will provide further help to develop end-of-life care services and provide incentives for better conditions.
	Many noble Lords have recognised the valuable role that hospices play in delivering end-of-life care services. The noble Lord, Lord Judd, spoke powerfully about a community’s sense of identity and ownership in their local hospice. Building on the success of the £40 million capital budget for hospices in 2010-11, which funded 123 projects in 116 hospices, the Government have provided a further capital budget for hospices of up to £60 million.
	The independent Palliative Care Funding Review panel, set up by the Secretary of State for Health, was asked to recommend how a new per-patient funding system for adults and children should be developed. It reported in July 2011 and was recommended by the Government. As noble Lords will know, pilots were set up as a result of this and are currently gathering
	evidence. This evidence gathering will finish in March 2014. We have already stated our position: we see merit in removing the means test at the end of life, and this is being considered as part of the review. Noble Lords will be pleased to note that we have committed to introducing the new funding system by 2015-16, which is a year earlier than recommended by the review.
	Before concluding, I thank those charities and hospices that do such wonderful work with patients at the end of their life, and with their friends and families after death to come to terms with their bereavement. In particular, Marie Curie, Sue Ryder and Macmillan Cancer Support have all been mentioned in today’s debate, but there are other smaller organisations.
	I hope that I have been able to offer some reassurance that the Government are making progress on these complex and sensitive issues. If there are any questions that remain unanswered, I will write to all noble Lords who have taken part in this debate.

Lord Dubs: My Lords, it was a privilege for me to secure this debate, in which there were some outstanding contributions. It was also very humbling to hear matters of conscience discussed so openly and with such obvious honesty and sincerity. I pay tribute to the right reverend Prelate the Bishop of Sheffield. I hope we will hear from him many times in the future, but perhaps on issues where he and I are in agreement. I am grateful to the Minister for the way she has dealt with this and to my noble friend on the Front Bench. All I can say is that we are going to debate these issues again and again.
	Motion agreed.

Global Fund to Fight AIDS, Tuberculosis and Malaria
	 — 
	Question for Short Debate

Lord Chidgey: To ask Her Majesty’s Government what assessment they have made of the impact of the replenishment pledges for the Global Fund to Fight AIDS, Tuberculosis and Malaria, made by world leaders in Washington in early December.

Lord Chidgey: My Lords, at their meeting in Washington at the beginning of this month, world leaders confirmed their pledges on the fourth replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Global Fund congratulated the UK on demonstrating strong leadership in global health, with a major contribution pledged to the Global Fund for the next three years. The United Kingdom will contribute £1 billion to the Global Fund for the 2014-16 period, the second largest pledge by any Government so far after the United States of America. Dr Nafsiah Mboi, the Global Fund chair, cited the extraordinary generosity and leadership of the United
	Kingdom since the fund was founded in 2002. She said that this new commitment would underline a transformative step forward for the Global Fund partners in their fight to defeat HIV/AIDS, TB and Malaria, and gave an inspiring model of responsible global partnership.
	Perhaps I may say at this stage how pleased I am that my noble friend Lord Fowler is in his place and will be contributing the benefit of his wealth of knowledge on these issues to the debate. I also welcome my noble friend Lord Verjee, who I am delighted to say has chosen to make his maiden speech in this debate. I know that my noble friend is able to speak from his personal experience in these matters and I look forward to his contribution today and to many more in the future.
	The United Kingdom commitment to the Global Fund is geared towards encouraging other donors to maximise their own pledges and thus unlock additional funds with each new pledge. Can my noble friend the Minister say in her response what has been the impact so far of the Washington pledges on securing new pledges, or even indications of new pledges, at this time?
	In its contribution towards ending world poverty, the United Kingdom is helping to halve malaria deaths in 10 of the worst affected countries by 2015. The United Kingdom has targeted saving the lives of 50,000 women in pregnancy and child birth, and 250,000 new-born babies, as well as helping to immunise more than 55 million children against preventable disease. The Global Fund pledging conference has set a target of $15 billion for the fourth replenishment. So far it has received $5 billion from the USA, the equivalent of $1.6 billion from the United Kingdom, and $612 million from Canada. A number of other pledges, notably from northern Europe, bring the total pledged to date to more than $12 billion.
	The Global Fund was created in 2002 as a public-private partnership to raise funds to change the course of HIV/AIDS, TB and malaria. The United Kingdom has now become the second largest donor after the USA, pushing France into third place. Since 2002, the fund has approved more than $23 billion for grants spread over more than 150 countries. The fund accounts for 21% of all international funding for HIV/AIDS, 82% of international funding for TB and 50% of global malaria funding. It is the biggest funder of programmes to prevent, treat and care for people with these diseases. Big strides have been made, with 9.7 million people receiving antiretroviral therapy for HIV/AIDS and a further 30 million mosquito insecticide-treated nets being distributed in the first six months of 2013, making a total of 340 million nets. My noble friend may be aware, however, of disturbing reports that in some areas these bed nets are being used as fishing nets, which is clearly totally inappropriate. Does her department have any details of this departure and the effect it may have on the impact of the fourth replenishment?
	The Global Fund’s TB programmes are continuing to expand, with the number of cases being supported now exceeding 11 million. However, the UK could be doing more, to which I shall return later. The UK’s
	latest £1 billion pledge to the Global Fund will maintain the record of “a life saved every three minutes”. Taking a lead in the worldwide fight against HIV/AIDS, TB and malaria, United Kingdom support over the next three years will deliver antiretroviral therapy to 750,000 people, 32 million more insecticide-treated mosquito nets to protect against malaria, and TB treatment for over 1 million more people. The UK’s allocation to the Global Fund will save a life every three minutes over the next three years and it will dramatically improve the lives of millions of people across the globe. Your Lordships will be aware that there are those who question the efficacy of organisations such as the Global Fund and its ability to channel the generosity of the United Kingdom into effectively combating diseases such as AIDS, TB and malaria. However, serious analysis confirms that the statistics demonstrate incontrovertibly that we can win this global battle on behalf of the poor.
	On a human scale, I am sure that noble Lords can recall, like me, witnessing the suffering of those afflicted by these diseases and their like. I think of my visit to a hospice in Soweto in 2004, where volunteers were comforting and caring for patients dying from AIDS. Many were too weak to speak and unable to understand what was happening to them, having been abandoned by their families. Left to die on the streets, they were brought into the hospice by volunteer community workers who had been trained in basic healthcare by a handful of dedicated nurses. Almost 10 years on, thanks to organisations such as the Global Fund, the ravages of AIDS are gradually diminishing, with the hope that they will become something of the past in due course.
	More recently, indeed just this summer, under the sponsorship of the charity RESULTS, I visited a district hospital outside Lilongwe in Malawi where small children were being comforted by their mothers as they struggled for breath and literally for life against the advances of pneumonia and TB. Further afield, at village health posts, I watched children being vaccinated by health workers, who were hampered by the fact that the transport of the cold boxes essential for the storage of vaccine was at the mercy of the poorly maintained and therefore unreliable fleet of motorbikes. Just to add to the difficulties, it was a 14-kilometre walk to the health posts for families living in the most remote communities.
	Considering the Global Fund’s present challenges and the UK’s responses, it is the case that the poor relation in the three worldwide health campaigns seems to be tackling tuberculosis. TB is contagious and airborne. It is the second most deadly infectious disease in the world, and last year it was responsible for 1.3 million deaths and 8.6 million new cases. TB is the leading cause of death for HIV/AIDS-positive people and is responsible for one in five HIV deaths—that was 320,000 deaths last year alone. TB is estimated to have killed more people than any other pandemic in history, and is developing a drug resistance which makes it more expensive and more difficult to treat, with many more adverse implications and side-effects for patients. An estimated 3 million people a year who develop TB are not officially diagnosed or treated, with no guarantee of treatment outcomes.
	The Global Fund has demonstrated that, with investment and leadership, significant gains can be made, but it needs to work with agencies such as DfID to be fully successful. It cannot operate in isolation. DfID can and should invest in issues such as TB which have an impact on health outcomes in the UK. DfID can and should prioritise issues that are important to the UK taxpayer. DfID can and should invest in new and innovative projects that could represent significant steps forward.
	TB is a largely neglected disease. Only one new drug has received regulatory approval in 42 years and the old-fashioned BCG procedure offers no protection to adults and cannot be used on people with HIV. Moreover, it does not protect against the most common type of the disease. It is estimated to cost the EU region alone almost €6 billion a year, yet the region accounts for only 4.7% of global cases. Leadership from DfID in a country like the UK could be transformative. It could lift the profile of the disease and show that it is still a major issue, which could lead to additional investment. DfID has provided a model response to malaria, putting it at the forefront of the global aid agenda. The 1.3 million people dying every year from TB and the 8.6 million who suffer from the disease need the level of support and commitment that only an aid agency like DfID can provide.
	I should be very grateful if, in her response, my noble friend could address this and the other issues that I have raised.

Lord Fowler: My Lords, I congratulate my noble friend Lord Chidgey on his speech and I look forward to the maiden speech which is to follow in a few minutes. I should perhaps declare a new interest. Last week I joined the board of the International AIDS Vaccine Initiative in New York. I agree entirely with what my noble friend has said in introducing this short debate, in particular about the value for money that the Global Fund represents and, of course, the contribution that it is making to the fight against TB. I will not repeat his arguments because I want to come to this issue from a slightly different position.
	Over the past 18 months, I have been looking at HIV and AIDS in different cities around the world. What has struck me is that when I explain this in this country, I am met with the response, “You mean, it is still a problem?”. It depends on what you mean by a problem. Last year some 1,600,000 people worldwide died from AIDS, while 2.3 million were newly infected, and for every person who was put on to antiretroviral treatment, two were infected. Some 36 million people around the world live with HIV, including 100,000 in this country, accounting for a drugs budget in the region of £800 million.
	It may be true that Africa has the biggest problem, but more than 2 million people live with HIV in India, while in Russia and Ukraine there are major problems of injecting drug users, home-made drugs and shared needles. Of those with HIV, up to a quarter are undiagnosed and, all other things being equal, continue to spread the virus. Even when people are on antiretroviral
	drugs, many do not adhere to the treatment, storing up all kinds of problems for the future. So, yes, not only is there a problem, but there is an acute and urgent challenge to every Government in the world. Thanks to the Global Fund and to the President’s fund in the United States, enormous progress has been made. The United States Government in particular should be given credit for what they have done—of course, I agree with my noble friend—as should the Government here, who have redeemed the pledge of my right honourable friend Andrew Mitchell to increase their Global Fund contribution. We should also recognise, however, that over the past few years the overall global contribution has remained stable in real terms; it has not increased.
	In no way do I deny the progress that has been made because it has been formidable and dramatic in terms of the number of lives saved, but I would suggest that the lesson is that we must not give up now. We should recognise what that means: we are talking about a lifetime commitment to people living with HIV. It is not a condition where, after treating a patient for six months, you can move on to the next one. That is one reason why the world needs to put far more emphasis than it has on preventing new cases of HIV. As I mentioned, I have joined the board of IAVI and did it for this reason. A vaccine gives the best hope for the future: you cut through some of the prejudice that surrounds testing and, from the financial point of view, it opens up the hope of reducing an otherwise constantly increasing bill. That was why—if I may say so to my noble friend—I was surprised and dismayed a month or two ago, before I joined the board, that the Government slashed the help from a hardly princely £9 million or £10 million down to £1 million.
	I accept that there is, at present, no cure and no vaccine—which is exactly what I said back in 1986. That means we have to do two things. First, we need to keep up our contributions to the Global Fund. It needs to be underlined that, in the vast majority of cases, that has been money well invested, resulting in tremendous advances and the saving of lives. Secondly, we need Governments globally to engage with the key minority populations where the risk of HIV is highest. It is absurd, unjust and counterproductive that homosexuality is criminalised in so many countries in the world. We also need to treat drug dependence as a medical issue, not just as part of a so-called and unsuccessful war on drugs, and to introduce more clean needle schemes, which we did in this country in 1987. We need to engage with people such as sex workers, where the rate of HIV remains very high, and not simply pursue a policy of looking the other way. We also need to fight discrimination against transsexuals, which often forces them into sex work.
	We have made massive progress, much of which is down to the success of the Global Fund, to which I pay tribute. However, we should also recognise that there is still a hell of a long way to go.

Lord Verjee: My Lords, it is with a very full set of emotions that I stand before noble Lords this afternoon to make my maiden speech in the House.
	These emotions are hard to describe but they include great trepidation, great gratitude and great humility. I will deal with the easy one first: great trepidation as I stand before this august House, full of its long history, tradition and the wisdom of all the noble Lords gathered here today. This would indeed be humbling for any new Member of this House and I will have a great sense of relief when I complete this maiden speech and sit down.
	I stand here in gratitude for so many reasons, including gratitude to my noble friend Lord Chidgey for introducing this debate. I am very fortunate to speak in this debate for many reasons. We are debating here a Global Fund not just for HIV but for tuberculosis and malaria, and in the country where I was born, Uganda, malaria is still the biggest killer. It accounts for nearly half of all the deaths of children in any one year.
	Ten years ago, I myself contracted malaria in the jungles of India. There are two types of malaria. There is the less lethal type that none the less revisits you and debilitates you year after year, and then there is what is called “cerebral” malaria, which goes straight to your brain and kills you. I had the second kind. That day, I could have easily joined the ranks of the well over 500,000 people who die of malaria every year. I was told I had only a day or more to live. It is only because I had access to the best medical treatment that I survived. Today, thanks to the deal that was recently made in Washington DC, far more people will survive and become malaria-free, as I did. I am proud to say that the British Government’s contribution to the fund has trebled, and we continue to be the second largest contributor in the world—for this, I am here to say thank you.
	I am also full of gratitude to all the staff, team, police and security personnel, and to Black Rod’s department, for all the most courteous, patient and kind help over the past few weeks as I so obviously wandered around very lost but trying hard not to appear so. I am full of gratitude, too, to my supporters: my noble friends Lord Dholakia and Lady Brinton. To follow in the immense footsteps of my noble friend Lord Dholakia is both a privilege and a challenge for a new Member of the House, and for me in particular, as we both hail from east Africa. I am full of gratitude to my noble friend Lady Brinton for all her help, support and confidence as we launched a leadership programme for my party that is designed to mentor and develop people from underrepresented groups so they can become MPs and participate in the governance of this country.
	I am full of gratitude most of all to the country and people of Great Britain. My family were dispossessed by Idi Amin of Uganda in 1972 because we were Asians, yet I was able to come here and prosper in this country and become an entrepreneur, and my family and I were able to live in freedom and dignity. This country gave me the opportunity to thrive and I truly hope I can help many more people to have that very same opportunity.
	The Global Fund and similar institutions provide these very same opportunities to people all over the world. I recently had the honour to travel with former
	President Clinton, who works with the Global Fund, to five countries in Africa. We visited Zambia, Malawi, Rwanda, Tanzania and South Africa, to see the projects supported by the Clinton Foundation. In Zanzibar, we visited a project called ZAPHA+, established some 20 years ago for Muslim women in a tiny community who had been stigmatised and shunned for being HIV positive. This project took them in, provided support groups and business skills for them and helped them to turn their lives around. When we visited, the women were happy, healthy and confident, and introduced us and President Clinton to their HIV negative children. It showed me what aid money can achieve when it is well spent. I assure noble Lords that the money committed by our Government will transform lives.
	Finally, I speak with a great sense of humility. The late President Nelson Mandela once said that,
	“after climbing a great hill, one only finds that there are many more hills to climb”.
	It has indeed been a great hill for me to climb from my birth in Uganda to my ascent into the House of Lords. I see now that there are many more hills to climb—hills on which there are people who need our help. I can rest at the end of this, my maiden speech, knowing that I will be climbing those hills together with other noble Lords. Thank you.

Baroness Hayman: My Lords, it is a real pleasure for me to be able to congratulate the noble Lord, Lord Verjee, on what I think all noble Lords would agree was an outstanding maiden speech. It was passionate, very personal and very modest. The noble Lord’s story is an extraordinary one of academic, entrepreneurial and philanthropic success. His business achievements are manifold, but anyone who has ever fought an election campaign will always owe him a particular debt of gratitude as the founder of Domino’s Pizza in the UK.
	In his speech, the noble Lord referred to what aid money can achieve when well spent. The noble Lord, Lord Verjee, is not only a generous but an intelligent philanthropist. He works, through the Rumi Foundation, in a variety of fields, but I pay particular tribute to the work that he has described today in encouraging, through the leadership programme, people from underrepresented groups to participate in political life. We hear and see a great deal about the perpetuation of privilege in public life in this country and it is enormously important that stories about those who overcome obstacles and the triumph of talent are also told as examples to others. I first heard about the noble Lord, Lord Verjee, from my son, who works in the philanthropic field. He said, “You should meet Rumi, Mum, he’s one of the really good guys”. I think that the House will share that opinion as time goes by.

Noble Lords: Hear, hear.

Baroness Hayman: When speaking about the Global Fund, I must declare my non-financial interests. I am a trustee of the Sabin Vaccine Institute, a vice-chair of the All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases and a trustee of the Malaria
	Consortium. I pay tribute to what the fund has achieved in the battle against malaria, to which the noble Lord, Lord Verjee, referred. Hearing the statistic that since 2001 the number of child deaths from malaria has been halved reminds you what aid money well spent can achieve. The Global Fund has been enormously important in that. The Malaria Consortium is the leading UK implementer of Global Fund money. In Uganda, with the fund’s support, we are working with the Ministry of Health to distribute more than 20 million long-lasting insecticidal nets to achieve universal net coverage in that country.
	As many have said in debates about the Global Fund, it is essential that we replenish the fund if we are successfully to continue and build on what has already been done. The fund is hugely important, not only in its own work but—as was made clear to me at a meeting of the all-party group last night—in the effect it has on the upstream work to face the new challenges and create the new vaccines, medicines, insecticides and diagnostics. While those are being developed, there must be the encouragement of knowing that there will be an implementation machine to take them to the patients. It is tremendously important that the fund is replenished.
	Replenishment will also allow the Global Fund to build and extend its work. I very much welcome the new funding model, which seeks to align investments in combating HIV, TB and malaria with national health strategies, while strengthening health systems and serving as a platform promoting the health of a person rather than combating only specific diseases. I feel this particularly strongly when I look at the issues of maternal and child health and of neglected tropical diseases.
	For the world’s poorest people, these things do not fit into nicely delineated silos and different funding streams; these are the health issues of the poor. To be effective, we need to combine the programmes to ensure that the synergies are achieved and the best value for money is obtained. I think of it most particularly with regard to schistosomiasis. Schistosomiasis increases by twofold or threefold the likelihood that an adolescent girl exposed to HIV will contract HIV. The treatment for schistosomiasis is very cheap but, as a neglected tropical disease, it does not fall within the bounds of the Global Fund. My question to the Minister is: what are the Government willing to do to encourage the Global Fund to take a broader approach to health in the future?

Baroness Nye: My Lords, I join the noble Baroness in congratulating the noble Lord, Lord Verjee, on his most eloquent maiden speech. I look forward to his future contributions. I, too, am grateful to the noble Lord, Lord Chidgey, for securing this important debate and for his efforts to keep the fund at the forefront of the development agenda.
	As the noble Lord said, the fund’s achievements have been remarkable: 6 million treated for HIV; 11 million diagnosed and treated for TB; and 360 million bed nets. I thank the Government for maintaining the
	support shown to the Global Fund by the previous Labour Government by making such a generous pledge. Although the replenishment campaign is over, the work of replenishing the fund must continue in order to ensure that it reaches its target.
	I, too, look forward to the Minister giving us an update on what the Government are doing to galvanise support from other donors to ensure that UK and US money is not left on the table and on what part they are playing to ensure the long-term stability of the funding stream. Only with sustained, long-term funding can you achieve the scale of the interventions needed.
	For all these efforts, gaps remain in our responses to these diseases. For 10 years, the UK charity Target Tuberculosis has been working in the field through local partner organisations, focusing on the needs of the poorest communities, who often live in remote locations far from government-led national TB programmes, which receive the bulk of the Global Fund allocations.
	Currently the British Government do not engage in any bilateral funding of programmes related to TB, despite the Prime Minister co-chairing a high-level panel report on the post-2015 framework that identified treating TB as the most cost-effective health intervention measured. It returns £30 for every £1 spent. Perhaps the Minister will explain why the British Government do not fund TB-specific projects through bilateral funding.
	In October the WHO launched its annual Global Tuberculosis Report in London with RESULTS UK, to which I am grateful for the work that it does and the briefing that it has provided for this debate. The report named five key priorities for beating the TB epidemic. I am going to concentrate on the need to:
	“Accelerate the response to TB/HIV”.
	Last year 1.3 million people lost their lives to TB. As the noble Lord said, 320,000 of those people were HIV positive. TB is the leading cause of death for people with HIV, yet only just over half of all those who are HIV positive and have TB can access anti-retrovirals. TB preys on a weakened immune system and, without access to anti-retrovirals, TB will progress faster in an HIV-positive patient. Co-infected patients without anti-retrovirals are more likely to die. A priority for reducing the number of deaths from TB and HIV is to scale up the response to co-infection and ensure that everyone with TB is tested for HIV, and vice versa, and given the proper medication.
	The Stop TB Partnership, the WHO and UNAIDS stated that 1 million deaths could be prevented among people living with HIV by 2015 if the world implemented simple strategies; that is, everyone with TB gets an HIV test and access to treatment. Worryingly, there remains a huge gap between where we are today and complete coverage of anti-retrovirals for TB/HIV patients, as the noble Lord, Lord Fowler, said. The recent DfID position paper reaffirming its commitment to TB/HIV is to be welcomed.
	The fund’s strategy committee has decided that it should do more on TB/HIV. It has mandated that any country with high rates of TB/HIV co-infection that applies for funding for treatment programmes will have to design its programmes in a single unified
	application. Every country will have to have joint, integrated, co-ordinated programmes for TB/HIV. This could be a huge step forward, as the fund provides 80% of international financing for TB and more than 20% for HIV. I urge the Government to take the lead and to support the Global Fund, not with money this time but by supporting and adopting similar policies and by urging other partners to do the same.
	Finally, in a week when the eyes of the world have been on South Africa, there is one other area where we could make a difference. South Africa’s gold mines contribute 9% of the global total of TB cases, which in turn fuel the HIV epidemic in the region. The British Government could show real global leadership and I hope that the Minister will update your Lordships’ House on the Government’s recent meetings with mining companies. The South African Health Minister and chair of the Stop TB Partnership board has called a regional gathering of Health Ministers and mining companies for early next year. The meeting will seek to drive a regional response to the disease. It would show real commitment if the British Government sent a high-level representative to that meeting. This is the kind of leadership that the British Government could and should provide. They have stated that TB/HIV is a priority; now I urge them to prove it.

Baroness Tonge: My Lords, I thank the noble Lord, Lord Chidgey, for securing this debate and congratulate the noble Lord, Lord Verjee, on a brilliant maiden speech—I congratulate him even more on surviving cerebral malaria.
	I have not exactly heaped praise on the coalition Government in the past three years, but I praise them for having the vision and good sense to see that overseas aid, prudently spent, not only benefits people in developing countries but will eventually benefit us all by reducing poverty and migration and increasing our markets abroad.
	Not being a great fan of “vertical lines of expenditure” on specific issues, I was sceptical when the Global Fund was set up, but I accepted that the three diseases that we are discussing were causing such devastation that a new approach was clearly needed—and the Global Fund was that new approach. It has been successful, as we have heard from the fund itself in the excellent briefing that we have received from it and from other noble Lords. I shall therefore congratulate the fund but not repeat what has already been said by other speakers.
	Replenishment of the fund is now needed, and we have heard of the plans for it. We must keep up support for the fund and nag other countries to keep pledges. Drug resistance is growing and we must stay vigilant.
	This applies also to my main interest, which is population and development, and expenditure on sexual and reproductive health, particularly family planning. According to the ODA, funding for population assistance is still increasing, but at a much slower rate than prior to the financial crisis. This is despite the tremendous boost given to accessible family planning by our coalition
	Government at the summit in London last year and carried forward by the Gates Foundation, to which we owe a huge debt of gratitude.
	Allowing women in the least developed countries to have access to family planning to limit the number of children they have is still crucial to the achievement of the millennium development goals. If the world’s population continues to increase, the MDGs become harder to achieve. We may feel that we are making progress, but more and more people coming into the world will need more help and more treatment. It is crucial therefore to keep up the pressure on family planning provision, always ensuring of course that there is no coercion. If you consult the statistics, you will see that economic growth always follows reduction in family size; it is not the other way round, as used to be believed. And that, reduction in family size, is the way out of poverty for most developing countries.
	One of the factors which led to my lack of enthusiasm for “vertical” programmes such as the Global Fund—this has been alluded to by the noble Baroness, Lady Hayman—is that while a patient may get his or her treatment for HIV/AIDS or TB, the provision of reproductive healthcare and contraception may be in another clinic or another place, necessitating another long journey to a health centre—and sometimes the provision does not exist at all. I am delighted, therefore, that the Global Fund is now trying to ensure that more comprehensive health systems will be set up alongside the treatments for AIDS, TB and malaria. I would love to hear the Minister’s assurance on that. There is a direct link, too: contraception in the form of condoms is after all the first defence against AIDS while we are waiting for a vaccine. Every health facility dealing with AIDS should remember this fact and have those available.
	Once again, I congratulate the Global Fund and the current and previous Governments on having achieved so much in international development during the past two decades, and I look forward to the next decade with some confidence.

Lord Shipley: My Lords, I, too, am grateful to my noble friend, Lord Chidgey, for securing this debate, just 10 days after the Global Fund’s replenishment conference. I join others in congratulating my noble friend Lord Verjee on an excellent maiden speech. I want, too, to congratulate the Government on their commitment to the fund, which has raised a remarkable $12 billion for the next three years and made unprecedented strides against HIV, TB and malaria.
	When the Economic Affairs Committee took evidence a couple of years ago on the economic impact and effectiveness of development aid, I noted in particular the evidence of Professor Jeffrey Sachs of Columbia University, who said he was,
	“a big fan of well targeted, well defined programmes that can accomplish well designed and specified purposes”,
	such as delivery of bed nets or vaccines. This is what the Global Fund helps to achieve: as we have heard, 11 million cases of TB have been diagnosed and treated, 360 million bed nets have been distributed to protect against malaria, and 6 million people have received life-saving antiretrovirals.
	However, huge gaps remain. Every year, there are 3 million people around the world who develop TB and are not officially diagnosed or treated and remain infectious. That number has not changed for six consecutive years.
	There is one initiative which would help: a Stop TB Partnership project called TB REACH, created with a grant from the Canadian Government amounting to $120 million. It is important because, while the Global Fund provides more than 80% of international financing of TB treatment, it is unable to fund projects that do not have a track record of proven success, which inhibits innovation.
	TB REACH undertakes feasibility studies for donors such as the Global Fund. It incubates innovations in TB care delivery; for example, using mobile phone technology, developing public/private partnerships and rolling out new, rapid diagnostic tests. That is exactly what it did in Ethiopia, where it supported a project that saw 1,200 community health workers team up with motorbike riders to get TB samples from remote villages.
	The project put a comprehensive package of measures in place to improve access to TB care. Health workers identified people who had been coughing for two or more weeks and collected sputum samples, prepared smears and supervised treatment, leading to a doubling of case detection and a 93% treatment success rate. That scheme has since been supported and scaled up by the Global Fund and the Ethiopian Government. It now has a sustainable future.
	However, I understand that there may have been concerns about the number of small projects that TB REACH funds, and about their sustainability and their scalability. Inevitably, with any initiative that funds innovation, not all projects will be a success and not all can be scaled up, and that is the price of innovation. But TB REACH is broadly successful, providing fast-track funding so that projects can deliver results within six months of a proposal being received. Its outputs seem impressive. In the past three years, TB REACH has contributed to the detection and treatment of more than half a million people with TB, through more than 100 grants in 44 countries targeting key groups including TB in mining communities and childhood TB. In addition, TB REACH projects have prevented 750,000 people becoming infected.
	I am aware of two reports that have the Government’s seal of approval. The first is the high-level panel report on the post-2015 framework, co-chaired by the Prime Minister. The report found that TB interventions offered the best return on investment of any health intervention. The other report is the recent DfID Health Position Paper, which identified the critical importance of innovation in solving the world’s most intractable health problems. I think that the Government are right to identify the importance of TB interventions, and the importance of innovation. I therefore hope that they will look very carefully at the strong case for extra funding for TB REACH.

Lord Collins of Highbury: My Lords, I, too, thank the noble Lord, Lord Chidgey, for initiating this very timely debate. I also congratulate the noble Lord, Lord Verjee, on his excellent and moving maiden speech, making a very powerful, personal case for the fund.
	As my noble friend Lady Nye said, the Global Fund to Fight AIDS, Tuberculosis and Malaria has since its inception provided 6.1 million people with life-saving access to HIV treatment, 11 million people with tuberculosis treatment, 360 million households with insecticide-treated nets to prevent malaria, and treated 260 million cases of malaria.
	As we have heard from noble Lords in the debate, it was rated as “very good” value for money in DFID’s 2011 Multilateral Aid Review, and continued to make progress according to the 2013 follow-up.
	As we have heard in the speeches this afternoon, the donors’ decision earlier this month to pledge $12 billion over the next three years is extremely welcome but still $3 billion short of the $15 billion needed. If that goal was achieved it would mean that: 17 million patients with TB and multidrug-resistant TB could be treated, saving more than 6 million lives over the three-year period; 1.3 million new HIV infections could be averted each year; and 196,000 additional lives could be saved from malaria, helping to avert a resurgence of the disease that could see the world return to levels of mortality not seen since the year 2000.
	Like the noble Lord, Lord Fowler, I pay tribute to the US Government for their action here. The US has committed itself to a one-third match of all funds raised up to the full $15 billion, so a further $1 billion is now on the table if other donors can step up to raise the remaining $2 billion needed. Like the noble Baroness, Lady Tonge, I am very proud of this Government for maintaining my Government’s commitment to the £1 billion funding. That places us in a strong position to exert influence over others for this round of replenishment. What steps will the Government and department take to help the fund realise the full $15 billion replenishment and thereby maximise the support from both us and the USA?
	Key to this will be more effective engagement with emerging economies that have the capability to support the fund. As we have heard in previous debates, India and China between them donated less than Ireland did on its own. For malaria, the Global Fund represents half of all international financing and will go a long way towards helping meet some of the urgent needs for prevention, diagnosis and treatment. Current prevention measures have dramatically reduced malaria cases and deaths, particularly in young children. The WHO World Malaria Report published yesterday shows impressive progress in the global malaria campaign. However, as quoted in today’s Guardian, Margaret Chan—director-general of the WHO—warned:
	“This progress is no cause for complacency. The absolute numbers of malaria cases and deaths are not going down as fast as they could”.
	The Global Fund also makes up more than 80% of all international financing for TB, making it the single most important funding mechanism in the fight against
	TB. If global funding for HIV, TB and malaria were to flat-line, we could see 2.6 million new HIV infections every year, some 3 million fewer people treated for TB, and 430 million malaria cases that could have been prevented. As Mark Dybul, executive director of the fund said:
	“We have a choice: we can invest now or pay forever”.

Baroness Northover: My Lords, I thank my noble friend Lord Chidgey for securing this important debate at a very important time. I also pay tribute to my noble friend Lord Verjee for his moving maiden speech. I am absolutely delighted that, with all his wide experience—as the noble Baroness, Lady Hayman, outlined—he chose to make his first speech in this debate, which I am answering. It is also excellent that so many noble Lords who have such an outstanding track record in this area, especially my noble friend Lord Fowler, have contributed. I thank noble Lords who paid tribute to what we are doing, especially my noble friend Lady Tonge, as I know how very hard won is her praise.
	As noble Lords made clear, AIDS, TB and malaria remain among the biggest causes of death and illness in developing countries. In 2012 alone, AIDS killed 1.6 million people, malaria 627,000 and TB 1.3 million. However, great progress has been made: new HIV infections are declining in many of the worst-affected countries; there has been a significant reduction in malaria incidence and deaths; and the world is on course to halve TB deaths by 2015, compared to 1990 levels. Just 10 years ago, the world struggled to respond to HIV, TB and malaria, and access to key prevention and treatment interventions was very limited—as noble Lords will remember. This picture has now been transformed and the Global Fund to Fight AIDS, Tuberculosis and Malaria has played a major part in this. Since 2002, Global Fund-supported programmes have detected and treated 11.2 million TB cases and distributed 360 million treated nets. Some 6.1 million people living with HIV are now receiving antiretroviral therapy thanks to the Global Fund. That is truly a remarkable achievement.
	However, as my noble friend Lord Fowler and the noble Lord, Lord Collins, pointed out, we must not give up now and cannot be complacent. Improvements are not uniform in all countries. As my noble friend Lady Tonge said, resistance to effective medicines is a growing threat. Devastating rebounds can occur quickly. That is why we must redouble our efforts and increase our commitment. As my noble friend Lord Fowler made clear, we now have a historic opportunity to make a decisive impact on these diseases. We have effective tools to prevent and treat them and an unprecedented global commitment to transform the three diseases into manageable health problems rather than national and global emergencies.
	Last week at the Global Fund’s replenishment conference in Washington, donors pledged $12 billion. That is the largest amount ever pledged—a 30% increase on the amount pledged at the 2010 replenishment conference. But $12 billion is only the start: the fund aims to raise a further $3 billion over the next three
	years to bring this to $15 billion and make the most of this historic opportunity. The UK is playing a groundbreaking part in that, as noble Lords noted. We are committing £1 billion—provided that that is not more than 10% of the total replenishment value—to encourage other donors to come forward and meet the target. Developing countries, civil society and the private sector also have crucial roles to play. Last week the Gates Foundation announced that it would provide up to $200 million to match other donor commitments. We hope that that will encourage new partners, including private contributors, to join the global effort.
	I assure my noble friend Lord Chidgey and the noble Baroness, Lady Nye, that we are working very hard to ensure that others follow suit. That is why the UK, the US and the Gates Foundation have made our contributions conditional. The most important role, of course, will be played by the countries themselves: designing effective national strategies; using funds transparently and well; and providing the bulk of financing from their own domestic resources. It was notable and historic that Nigeria participated in Washington as an equal partner, committing $1 billion for investments in treatment, care and prevention for Nigerian people affected by the diseases.
	The noble Baroness, Lady Hayman, asked about the broader health sector support for the Global Fund. Clearly, the focus of the Global Fund is on the three diseases, but there has been a widespread understanding of the effect that it has on other diseases and the importance of ensuring that action in one area is supported by action in another, and that it is important to look across the sector. Whether it is neglected tropical diseases or family planning, to which the noble Baroness, Lady Tonge, referred, it is recognised that these areas interplay.
	The noble Lord, Lord Fowler, asked about key populations. We strongly support a public health approach to key populations affected by HIV, including men who have sex with men, sex workers and injecting drug-users, that respects human rights and addresses the stigma and discrimination that they face. It is very important that that is recognised.
	Of course, we wish to see the money spent effectively. On the misuse of bed nets, I can assure my noble friend Lord Chidgey that the World Health Organisation’s World Malaria Report 2013, which was launched yesterday, estimates that 86% of people who had access to a bed net used it to protect themselves from getting malaria. We are supporting efforts to maintain and increase that.
	On TB, we are committed to the global goal of halving deaths from it by 2015. Various noble Lords mentioned this. The noble Baroness, Lady Nye, suggested that there were no TB-specific bilateral programmes. The majority of UK funding for TB treatment is through the Global Fund, but we are providing bilateral funding to TB-specific programmes in a number of countries, including South Africa, Burma, Nigeria and India. In August, we announced support for nine public-private partnerships, including FIND, the TB alliance and Aeras. These partnerships will help fund crucial work on developing new and more effective
	tools to prevent, diagnose and treat TB, in addition to our spend through the Global Fund.
	In addressing my noble friend Lord Shipley on TB Reach, I will say that we have reviewed its external mid-term evaluation and agreed that it has successfully funded innovative approaches leading to additional TB cases being detected among high-risk populations and in high-burden countries. Besides supporting it through the Global Fund, DfID also supports TB Reach through our £53 million annual core support to UNITAID.
	The noble Baroness, Lady Nye, spoke of integrated approaches to tackling TB and HIV, which is something that her noble friend Lord Collins put to me the other day. DfID has been leading in this area, and we have been strongly involved in the recent Global Fund requirement for countries burdened by the two diseases to put forward a unified and integrated application for joint TB/HIV programmes. This is a strong signal that disease-specific initiatives will not address TB/HIV co-infection alone. That is also highlighted in DfID’s HIV position paper review, which has just been published, because we recognise the importance of co-infection.
	In terms of working in the extractives industry, which the noble Baroness, Lady Nye, also brought up, we are working with the Government of South Africa, the Chamber of Mines and the World Bank to expand the quality and access of TB-related services, including TB control and treatment referral across borders. There are some other details, which I can provide to her.
	We now have to ensure that we use the funds pledged at the recent conference, and those that will follow, as we seek to meet the $15 billion requirement for the Global Fund. We have to make sure that these funds are used in the most effective way possible, so that we achieve the greatest impact from the money contributed. The UK will continue to work closely with the Global Fund to ensure: that we are financing the highest-impact interventions; that we are increasing funds to the lowest-income or most fragile countries with the greatest disease burdens; that we are focusing interventions on the most at-risk populations, using the latest epidemiological evidence to target disease hotspots in country; and that we are using funds to support implementation of robust national disease strategies with full country ownership.
	We will ensure that the Global Fund implements and builds on its new systems of governance and risk management, so that no one is denied access to life-saving treatment due to a loss of funds through fraud and corruption. We must not forget the importance of shaping markets and reducing costs, and have made huge strides already in this area, which I think that noble Lords are familiar with. But with continued work, we believe that further sustainable price reductions are possible, so that more lives can be saved for every £1 raised.
	The $12 billion pledged in Washington is the start of a process towards full replenishment and achieving the maximum impact from $15 billion. This in turn is part of something bigger, with vital contributions from other donor sources, the private sector, civil society, and, most importantly, from the countries
	themselves. Working together in a true global partnership with clear goals and targets and unwavering national and global commitment is the only way to end the death and suffering caused by HIV/AIDS, malaria and TB.

House of Lords: Size
	 — 
	Motion to Take Note

Moved by Lord Norton of Louth
	To move that this House takes note of the case for reducing the size of the House of Lords.

Lord Norton of Louth: My Lords, the proposition I wish to put to the House is straightforward. In terms of membership, the House of Lords has grown, is growing and ought to be reduced. There is an immediate problem; there is an even greater prospective problem.
	My starting point is that this House does a good job in fulfilling functions that add value to the political process. It complements the elected Chamber, not least in carrying out tasks that the other House may not have the time, resources or political will to fulfil. However, the fact that we do a good job does not mean that we could not be even more effective than we are. Enhancing our effectiveness has two elements. One is making changes to how we operate and the other is bolstering public confidence in what we do. Unlike the other place, we cannot take our legitimacy for granted. We have to earn it. The changes that would enable us to fulfil our functions more effectively and enhance public support go well beyond limiting how many Members we have. However, addressing the size of the House is critical because of its relevance to fulfilling the functions of the House and our public standing.
	There are two aspects to the size of the House. One is the total membership and the other is the active membership. The total membership is especially relevant to how the House is seen by the public, and the active membership is relevant to the capacity of the House to do its job. In terms of total membership, the House has grown markedly since the passage of the House of Lords Act 1999. At the start of the new Session of 1999-2000, we had 666 Members—in other words, a membership slightly larger than that of the House of Commons. Today, we have a total of 835 Members, making the House more than a quarter larger than the House of Commons. We are the largest second Chamber in the world. That remains the case even if we exclude those who have taken leave of absence or are ineligible. Excluding those who are ineligible or have taken leave of absence, we have 781 Members. However, we have to take into account the fact that ineligible Members, such as those holding judicial posts, will in due course be able to resume their seats. Some of those on leave of absence because of the positions they hold, such as the noble Baroness, Lady Ashton of Upholland, may well resume their seats upon completion of their current posts.
	However, even working with the figure of 781, imagine what will happen if a new list of Peers is announced. Then think ahead to the next Parliament and the likely creation of another list. There may be ebbs and flows—we lose some Members each year and there is a lull between lists—but the underlying trend is clear. That is demonstrated graphically in Figure 2 of Meg Russell’s pamphlet, House Full, published in 2011. As she points out, the largest single number of Peers to be created in any one year since 1999 was the 117 who were created in 2010-11.
	The number, be it of all Peers or just of eligible ones, is rising and has risen most markedly in the past three years. It is not beyond reason to envisage a House at some point in the next Parliament with a total membership close to, or even in excess of, 900 Members. A House of that size, whether active or inactive, does nothing for the reputation of the House; it is difficult to defend in the public arena.
	One can certainly justify a House similar in size to that of the other House, given that we need a large membership to sustain an active House of part-time Members. We benefit fundamentally from Peers having outside links and maintaining current expertise. This House forms an invaluable arena for discourse by civil society. However, the more that we grow in number beyond the size of the other place and, like Topsy, just grow and grow, it is difficult to defend against the criticism of being primarily an expanding repository of political patronage.
	There is no obvious justification for the expansion in terms of fulfilling the tasks that are core to our activity. The more that we grow in size, the more that the position becomes indefensible. It would not be bad if there were a rational argument for the growth in numbers, but there is no clear intellectual basis for it. The composition of the new membership in this Parliament bears little relationship to the stated aim of the coalition agreement in terms of membership proportional to votes in the general election. To achieve proportionality now would require a further, substantial injection of new Peers.
	There is a more tangible problem in terms of the resources of the House. The growth in membership in recent years has brought in Members who contribute regularly to the work of the House. This is reflected in the daily attendance: the average daily attendance in the Session 2009-10 was 388, while in the most recent session, 2012-13, it was 484. As Meg Russell records, this substantial recent growth in the active membership generates three problems. First, it puts pressure on the limited resources of the House. Secondly, it puts pressure on the work of the House, not least in terms of demands to contribute to Question Time and debates. Thirdly, it has a negative impact on the culture of the House. The more that Members are brought in quickly and in large numbers, the more that this makes it difficult to socialise Members in the accepted norms of the House, and the danger is that the House may become more fractious and partisan.
	The pressure on resources is fairly obvious, not least in terms of space. Members have always been underresourced relative to Members of the other place. This is shown in the extent to which Peers are allocated
	not offices of their own but rather desk space. The pressure is also obvious in the Chamber, in that at various times it is not able to accommodate all the Members who wish to attend. We have a smaller Chamber than that of the other place but a larger membership. The Commons has seating for more than 60% of its Members; we cannot match that, even based on the average daily attendance, and the situation is clearly growing worse.
	The increase creates particular problems in a House that works on a fairly lean support base. The cost of this House is notably less than that of the House of Commons. In the previous Session, the cost to the public purse of the House of Commons was £392 million while the cost of the House of Lords was £87 million. We may take some pride in delivering value for money, but making a case for more public money at the present time is difficult. We are expected to make efficiency savings. That will be difficult with an influx of new and active members, each eligible for an attendance allowance and transport costs and adding to the demands on the resources of the House. There is clearly a problem in how this will be seen by the public. There is also the problem of how we can cope within our existing physical capacity and administrative support. The demand is in danger of outstripping the ability of the House to meet it.
	So the situation that we are in is clearly problematic, and if there are many more creations then it will likely become unsustainable. What, then, is the answer? There are various steps that can be taken, although in taking them it is important to have regard to certain principles. One is that no party or coalition of parties forming a Government should have an absolute majority. Another is that there should be a protocol, a formula, on the balance between the parties in order to prevent another escalation in membership. Any reduction needs to have regard to the balance between political groupings in the House. A third is that we should work towards a membership that is smaller than that of the House of Commons. That may take time but it is a useful aspiration; it provides a framework for managing the reduction in numbers.
	One immediate and rather modest step would be to put a limit on the size of the House. One proposal is to have a moratorium on the creation of new Members. I would propose a cap on membership. That way, one could create new Members but only when existing ones had demised. One could develop a formula of creating, say, only one new Peer for every three who left the House. That would gradually reduce the size of the House; it would be a slow process, but over the course of the Parliament it would reduce the size of the House by at least 50.
	Other steps include those embodied in the Bill introduced in this House by the noble Baroness, Lady Hayman, and that in the other place by Dan Byles, such as removing Peers who hardly ever attend. That would not affect the active membership but would have a beneficial effect in terms of public perception. Another provision of the Bill would create a form of retirement provision, which would have the effect of the Members ceasing to be Members of the House, with no provision for retirement to be rescinded.
	More radical proposals have been canvassed. These include proposing a mandatory retirement age or imposing a set period for which a new Peer may serve, such as 10 or 15 years. The problem with each of these is that it has the potential to rid the House of Members who are making a substantial contribution to it. There is another proposal that would not have such an arbitrary effect and could be geared to the need to maintain a balance between the parties in the House and allow for some recalibration in each Parliament: to determine the number that each political grouping should have in a Parliament and to allow each to elect from within its own ranks those who should remain within the House—in other words, a scheme not dissimilar from that employed in 1999 to determine which hereditary Peers should remain in the House.
	My purpose this afternoon is not to put forward a particular proposal, but rather to emphasise the necessity to address the problem. The more we can get on record the need to act, the sooner we may be able to achieve some steps by government to address the compelling need for some corrective action. Accepting the need for a cap on membership would be a starting point.
	Given that, may I invite my noble friend the Leader of the House to focus not simply on where we are now, but on where we are likely to be in two, five and 10 years’ time? In terms of creations already announced, could he give us some indication of the additional costs estimated to be incurred in a full financial year once the introduction of the current tranche of new creations has been completed? Does he accept that a further list of Peers in the current Parliament will create not just additional but significant difficulties in terms of the finite resources of the House? Projecting ahead, would my noble friend accept that the problem will be exacerbated in the next Parliament, especially in the event of the return of a new Government? That will be the case if the new Government is a majority Conservative Government. Would not the new Government expect to create more Peers? If my noble friend accepts that there is a problem, either now or prospectively, what steps does he anticipate the Government taking to address it?
	The problem has been touched upon by various bodies in recent years, including the Leader’s Group chaired by my noble friend Lord Hunt of Wirral, who I am delighted to see in his place, as well as more recently by the Political and Constitutional Reform Committee in the other place. My noble friend told the committee that he found that there was a broad consensus among Members that the current House is too big and the overall size should be reduced. Given that there is such a consensus on the problem and what should be done about it, I look forward to hearing from my noble friend, speaking as the Leader of the House, what he plans to do to give effect to the will of the House. I beg to move.

Earl Attlee: My Lords, may I point out to the House that the timings are very tight indeed for this debate? I can help.

Lord Tyler: My Lords, I congratulate my noble friend Lord Norton of Louth on this very timely debate. He and I gave evidence to the Select Committee of the other place that looked at this issue, and I shall briefly refer to its report because it was rather useful for people outwith this House to look in, although it has to be said that very many distinguished Members of this House gave evidence to that committee. My noble friend referred to some of the issues looked at—for example, the proposal that there should be legislation to expel Peers who have been convicted of a serious offence. I do not think that reform would produce a serious decrease in the size of the House; I would hope not.
	The committee recorded strong agreement that action should not be taken in two areas: first, in relation to the introduction of a long-term moratorium on new Peers, and secondly, in relation to the introduction of a compulsory retirement age. It specifically said that it did not think either of those things were appropriate or would receive proper support in either House. The committee went on to say that there seemed to be some widespread support for no longer replacing hereditary Peers in the House of Lords when they died. That has proved very contentious in this House, so maybe there was a certain naivety at the other end of the building on that issue. On the other hand, the committee quite sensibly pointed out that tackling the issue of persistent non-attendance is by definition not particularly useful in dealing with problems of overpopulation in this House. It is a classic non-solution. Finally, it said that it thought that the evidence about introducing fixed-terms appointment for Peers suggested that it would prove to be just as controversial as some of the more major reforms that both Houses have been looking at in recent years.
	The chairman of that Committee, Mr Graham Allen MP, said in introducing the report:
	“Establishing a consensus about the principles that should determine the relative numerical strengths of the different party groups in the House of Lords, and for codifying such principles, is probably the most contentious of all the issues we considered in this inquiry, but it is also the most crucial to any further progress. We call upon the Government and political parties in the Lords to set out their positions on this matter and to engage in dialogue that will establish a consensus before the next General Election, so that both Houses can act upon an agreed reform”.
	My noble friend the Leader of the House may be able to respond to that challenge. I was disappointed that the committee did not see fit to take evidence from my noble friend because on a number of occasions in this House he has given a very effective, robust and rigorous analysis of the issue of active membership of this House, which is not fully explored in the Library note, which is otherwise excellent.
	The search for consensus is fascinating in politics, not least in this building. My very good friend Dr Chris Ballinger of Exeter College, who has given evidence to a number of committees, said recently that,
	“seeking a perfect reform through consensus is a fast track to inertia”.
	I suspect that is where we are again today. Already we can see that Dan Byles’s Private Member’s Bill, which
	has now come to our House and is based on the previous Bills introduced in this House by my noble friend Lord Steel of Aikwood, whose Bill was passed by this House, and the noble Baroness, Lady Hayman, is likely to be squeezed out in the current Session by the Conservative high command’s insistence on giving precedence to the European Union (Referendum) Bill. Is there really a chance of making progress in this Session—I doubt it—or the next Session, a few months before a general election? Presumably we can now confidently assume that all three major parties will reiterate their previous and repeated manifesto commitments to full reform of this House. It would presumably be perverse if Labour failed to commit itself to legislation which incorporated all the main features of Jack Straw’s White Paper of July 2008, including specific recommendations on the transitional, steady reduction in the size of the House. I am delighted to see the noble Lord, Lord Hunt of Kings Heath, in his place this afternoon. He was not only a crucial author of those proposals; I think that he was really the godfather—I mean that in the nicest sense, not the Italian sense.

Lord Hunt of Kings Heath: I just say to the noble Lord that I continue, with him, to seek consensus in this matter.

Lord Tyler: We may both of us lose more hair before that happens; even so, I welcome his support.
	There was in both Jack Straw’s White Paper and the Bill a specific, careful, planned reduction in the size of the House. Can we expect those proposals in the Government’s 2012 Bill to see the light of day again? There is a mystery here. I heard just recently in your Lordships’ House a distinguished Member—indeed, a distinguished former Member of the other place—say that the Government’s Bill had been defeated. Not so: that is a myth. It was not defeated. On 10 July 2012, the House of Commons gave the coalition government Bill a record majority at Second Reading of 338 votes. Even more significantly, there was a substantial majority of supporting MPs in all three major parties: 193 to 89 Conservatives; 202 to 26 Labour; and 53 to zero Liberal Democrats.
	As we all know, the Labour leadership, understandably perhaps, refused to support a programme Motion—any programme Motion—so the Leader of the House had to announce that no progress could be made. The Prime Minister sought agreement to press on but failed to achieve it. The Bill was pulled, not defeated. Indeed, had Labour not sacrificed its principles and manifesto promises on the altar of temporary expediency, there would now be a reform Act, or one on its way, as a result of the Parliament Act. The problem of the long-term size of the House would have been solved, but by the votes of our fellow citizens rather than by the contrived patronage or blackballing of party bosses.
	We can all speculate about the outcome of the next general election in May 2015. Maybe there will be a dramatic swing to the right. Maybe it will end up with a coalition between UKIP and the Conservatives, but I think that that is unlikely. It therefore seems to me that in May 2015, which is not that far ahead, the
	noble Lord, Lord Hunt and I may well see a consensus in the other place that we should make progress on a Bill with that considerable support. This problem, so well identified by my noble friend Lord Norton of Louth, may therefore be on its way to a solution, not because of what the parties say but because of what the people say.
	Winston Churchill was once a great Liberal—some people think that he lost his way later on in life—and at one point he said, “Let’s trust the people”. I think that that would be my position.

Lord Kakkar: My Lords, I, too, congratulate the noble Lord, Lord Norton of Louth, on having secured this important debate. In so doing, I declare my own interest as chair of the House of Lords Appointments Commission. The noble Lord, Lord Norton, raises an important issue which has implications for the practical discharge of the work of your Lordships’ House, as he rightly pointed out in his excellent introduction to the debate. It also has an important impact on the external perception of your Lordships’ House and therefore more broadly on the regard and standing of Parliament.
	It is therefore vital that we look at the size of your Lordships’ House in the context of what the ongoing role of a second Chamber might be in the 21st century, in a bicameral Parliament where the primary Chamber enjoys the democratic mandate and has reserved for itself specific powers with regard to supply and confidence; and where there is a convention that your Lordships’ House does not frustrate the will of the primary Chamber but, rather, plays an important and active role, respecting the democratic mandate of the primary Chamber; in scrutinising and revising legislation, ensuring that our fellow citizens can live under the best possible laws that have been informed by active consideration in your Lordships’ House; by holding the Government to account, applying itself in a rigorous and fastidious fashion, questioning what the Government are doing and how the Executive are discharging themselves; and, of course, stimulating and initiating debates and inquiries which address concerns of national importance.
	To discharge those functions, your Lordships’ House has concentrated on work in the Chamber, but also in Grand Committee and a number of Select and ad hoc Committees, currently over 30, populated by noble Lords who bring unique insights and expertise to their work. It is in that context that we need to consider how your Lordships’ House should be populated in the future. A driving principle of membership of this House has been that it brings experience, insight and expertise to much of the work that it does.
	That has been an important and distinguishing characteristic of the composition of your Lordships’ House and it helps us to distinguish it from the other place. Therefore, in considering questions of the future size of your Lordships’ House it is important to understand whether at the heart of that particular question your Lordships and those who are in a position to make appointments to the House are fully cognisant of the current composition of the House and, in particular, what expertise exists within it.
	For instance, do we have any clear understanding of the range of expertise that is required in a Chamber of this nature to be able to address issues of complexity in terms of modern legislation? How frequently is the declared expertise brought to bear in addressing in detail—in Committee and in work in the Chamber—the kinds of issues of legislation that your Lordships’ House is faced with, to ensure that the citizens of our country can be certain that they live under the very best laws, which have been thoughtfully considered? How often are we able to refresh that expertise to ensure that we are able to discharge our constitutional responsibilities? How can the House go about identifying the kinds of issues—and therefore the kinds of expertise—that might be required on the horizon to ensure that we can continue to discharge our responsibilities to scrutinise and revise legislation appropriately?
	An important example of one of the areas where your Lordships’ House has taken a particular leading role in this Parliament is on the question of the scrutiny of legislation from Europe. I declare a further interest as a member of Sub-Committee B of your Lordships’ European Union Committee. The work of that network of European Union committees is highly regarded. It informs debate in the other place, and of course it informs further consideration among the European institutions and among other member states. How are we to ensure, when considering the size of a future House, that we retain that type of expertise?
	Your Lordships’ House has another very important function in this bicameral Parliament. That is to ensure that Parliament, in the broadest sense, is able to reflect the diversity—in age, gender, ethnicity and in geography—that reflects our country as a whole, and which may not always be achieved through the ballot box and our particular electoral system in terms of membership of the other place. It would be a great pity, when considering questions about the size of your Lordships’ House, if those important defining characteristics were lost through the application of arbitrary solutions. That is not to say that the question of size is not an important one, but in addressing that question, your Lordships and others must be sensitive to the fact that your Lordships’ House, as the noble Lord, Lord Norton of Louth, said in his introduction, works well, discharges those important responsibilities, and must be able to do so in the future.

Lord True: My Lords, it is always a great pleasure to follow the noble Lord, and I agree wholeheartedly with what he said about arbitrary solutions. I thank, as have other noble Lords, my noble friend Lord Norton of Louth for initiating this important debate. However, sometimes, and increasingly, it seems that debates about our own future are becoming like the story of Penelope’s tapestry in Homer’s Odyssey: great labour, ingenious designs, but of it there never comes an end.
	That this House should be comfortable with itself is important. But if the belt fits a little tightly at some times and in some places, is that the end of the world? We did not need too many sharp elbows to get to our
	places this afternoon; some looking on will be bemused at the idea that a House so allegedly overcrowded looks so empty. What is so urgent or damaging about this alleged problem that it claims our monthly attention? Surely it cannot be that some, as well as not wanting hereditary peers any more, do not want too many more like ourselves. I express my unqualified welcome to new Members of the House on all sides—I am sure they will enrich our work.
	Most of your Lordships have recently rejected a reduction in the size of the other place. The House also set its teeth, as my noble friend Lord Tyler said, against the solution of election of a set number of Peers to stock the political Benches of this House. That would be the easiest way to set a cap on the political sides of the House, while preserving through appointment the independent expertise of the Cross-Benchers.
	This House is still one of the cheapest in the world. Why are we agonising so much about cost? It continues to be a House of expertise, unpaid and part-time. Few here want to change that. Such a House inevitably needs a larger pool of Members from which to draw to do its work. There are high hopes of proposals for permanent retirement, and I welcome them, although I could not support a payment to leave. Voluntary retirement would be preferable to compulsory ejection of Members who reach a certain age—and I agree fully with the comments of my noble friend in the report of the Commons Select Committee on this issue.
	In a country where policy-making and comment on it is ever more dominated by people under 45, while the growing majority of the electorate is—and will continue to be for the foreseeable future—over 45, it seems highly eccentric to seek out one of the few parts of our constitution where the voices of older, more experienced people are regularly heard and to force them out. It is often a little more experience and a much longer view we need in the counsels of the state, not less. So I am against age limits.
	The arguments for a formal cap on the size of an appointed House raged three centuries ago over the Peerage Bill in 1719, and were skewered very effectively by Robert Walpole in debates on that legislation, not only by frightening his fellow MPs that, if they voted to limit the size of the House of Lords, a pleasant retirement home would be denied them, but on the more serious basis that a firmly capped unelected House could not be overborne by new creations if it brought a government to deadlock. Creation to secure the Crown’s business was needed or threatened in 1711, 1832 and 1911, and some of us are old enough to remember hearing Tony Benn call for 1,000 Peers to carry Labour’s programme of 1976. Even with the cumbersome blunderbuss of the Parliament Act, an unelected House can still disrupt business, as we all recently experienced. There needs to be an ability to break a cap, and defining that would be difficult.
	Nor is a moratorium reasonable for obvious reasons of renewal and political balance. Roughly half the existing life peerages were recommended under the Blair Governments of 1997 to 2007. It is a little chary, in this light, to chunter that my right honourable
	friend the Prime Minister is overegging it. Mr Blair allowed only 49 Conservative Peers in his first two Governments; my right honourable friend has allowed 44 additions to a Labour Party that was already the largest in the House in one as yet uncompleted term. In his first three years, Mr Blair appointed Labour Peers at a rate 50% faster than that allowed himself by Mr Cameron in appointing Conservative Peers. Mr Cameron has, by contrast, been actually restrained.
	We have been through a stage of exceptional creation—a missile-building period—and the House will take time to get over the hump of those massive creations. But I think that it can return progressively, as I hope that it will, to the lower rates of creation that were standard in the past. There may well need to be a steady decommissioning of the stacks of Back-Bench ICBMs, waiting in the Bishops’ Bar to come into Divisions—but with patience and a will, it can be done. Even in the quarter century from 1905 to 1929, which included the Lloyd George era, the average was 11 creations a year. In 1929 to 1955, with many changes of Government, it was 12. Those figures are less than the number of those leaving the House in every year so far this century—and, with an average age of 70, sadly, the number of leavers, is likely to be steady in the years ahead.
	We should be far more relaxed on this score, stop constantly fussing about the matter and turn our attention to other affairs of state, although I think that ingenious heads might come together in the usual channels to consider the active House and the escalating size of Divisions, the main reason why many are called to the House day by day. Pairing would be extremely difficult in this House, partly because of the coalition but also because of the existence of Cross-Benchers. However, a search for a START treaty in the usual channels might bear fruit, if searched for. If some of the Peers who do not intend to take part in proceedings could be slipped from the duty to vote, the House could keep, and draw on, the pool of their wisdom while not flooding the byways of the House for the more humdrum Divisions that punctuate our lives. That task would be difficult but I hope that the Front Benches might rise to that challenge and prefer it to mechanistic and legislative solutions.

The Lord Bishop of Leicester: My Lords, this House owes a debt to the noble Lord, Lord Norton, for his assiduous work towards creating a more effective second Chamber. As usual, he has today rehearsed very clearly and effectively the case for reducing its size.
	It seems to me that the challenge is clear. In spite of the speech of the noble Lord, Lord True, there is surely overwhelming agreement with the fundamental proposition that this House is too large. The question, therefore, is to find ways not just of agreeing with the principle of creating a smaller House, but to give effect to it. In that sense, this debate is part of a wider discussion upon which hangs the reputation and credibility of the political class.
	A noble and right reverend former Bishop of Durham said about Lords reform a few years ago:
	“I would rather be a Member of an upper House which works effectively as a revising and scrutinising Chamber than retain membership of one which is not fit for purpose”.
	For the avoidance of doubt, I do not quote this in order to offer up this Bench for abolition but rather to make a different point about what will bring about change; namely, that the overriding issue for examination needs to be what makes for the good governance of our country. On that point hang successive submissions from the Church of England in the past 10 years, and I believe it is on this basis that the debate should proceed.
	This Bench supports the thrust of the proposals of the noble Lord, Lord Norton. We passionately believe that the function and, therefore, the character and composition, of this House needs to be different from that of the other place. To achieve that, any reduction in size needs to maintain true and impartial accountability and to represent the breadth and diversity of civil society and intellectual life. Therefore, any reduction in numbers will need to have regard to the proportion of independent Members as the pressure for political appointees continues to mount.
	We will see nothing but serious dysfunction if these principles are not given effect soon. The coalition agreement appears to enshrine the doctrine that membership of your Lordships’ House should reflect the proportions of votes cast at the 2010 election. Unless there is change, and if this doctrine continues to obtain, we all know that the consequence will rapidly become unmanageable. If the suspicion is to be allayed that the necessary limited reforms of this House are being frustrated in order to create the conditions for more radical reform, surely we need to proceed to action soon. This House is not, and never has been, a Chamber embodying the doctrine of proportional representation—our character, purpose and raison d’être lie elsewhere.
	I speak from a Bench whose Members are required to accept the disciplines of a cap on numbers and a final retirement age. Certainly, those limitations have not prevented this Bench playing a full part in the range of policies and laws which come under scrutiny in this House. Indeed, a process of appointment which is time-limited and number-limited enables Members of this Bench to reflect our regional involvement and speak not out of self or party interest but rather reflect the truth that profound moral and ethical questions surround a great deal of the work of your Lordships’ House. From this experience we have consistently argued in favour of measures to allow for the expulsion, retirement and suspension of Members of a reformed House of Lords, believing those measures to be the interests of this House and of Parliament more widely.
	However, we need to be open also to reform on this Bench. We have indicated in evidence to the Select Committee on the Clegg Bill that we would be willing to work with government to find ways in which a small Bench of Lords spiritual in a proportionally reduced House could continue to play its full part in its proceedings and offer rather more than is presently possible. More immediately, we have begun to explore the possibility of modification to the Bishoprics Act, which governs the succession of Lords spiritual after a vacancy, in order to make it possible for women who may be ordained as bishops in the next few years to be fast-tracked
	to this Bench. I am glad to say that the Prime Minister was able to give an encouraging response to the Second Church Estates Commissioner when asked about this recently at Prime Minister’s Questions.
	Many of the issues raised by this debate were extensively explored by the Select Committee of both Houses, of which I was a member and which gave pre-legislative scrutiny to the Deputy Prime Minister’s reform Bill two years ago. I cannot remember a single witness to that committee, or a single member of it, arguing that the present size of this House is optimal. What we do here is of vital importance to the nation. We surely cannot tolerate increasing and inevitable dysfunctionality. My hope is that this debate will help us to define some practical proposals around which it will become possible for all of us to gather, and soon.

Lord Maclennan of Rogart: My Lords, I express my appreciation to the noble Lord, Lord Norton, for introducing this debate—and for doing so in a thoughtful way, as is his wont.
	I must say, however, that the real question that has to be asked about this House is: does it do its job properly and with effectiveness? The answer has to be that it does. That is increasingly clear. Meg Russell, probably the greatest scholar on this House, has indicated the impact that we have on the legislative process. That impact has grown since the reform of 1999, when there was a self-denying ordinance to some extent. The Select Committees of this House also give great scope, perception and insight to others who are contemplating legislation in these fields. As a member of the Select Committee on the European Union and its sub-committee on external affairs, I am conscious of how well regarded the work of the committee is, not just in this country but in the other member countries of the European Union.
	The main problem that we face, which has been raised by the noble Lord, Lord Norton, comes from the lack of understanding of the role played by this House, which is largely due to the press and media—particularly the press, which used to quote in columns what was said in the debates in the House. In the broadsheets, that gave some weight to our deliberations. I regret that we now suffer mostly from comment that is to some extent derisory and does not convey the practical reformative work that is being done here.
	There are modest changes that could be made and they have been largely encapsulated in the Bill produced by the noble Baroness, Lady Hayman: the changes providing for permanent retiral, ending by-elections of hereditary Peers’ successors, enabling those who do not attend a full Session of Parliament to come back, and excluding serious criminal offenders. Those all seem commonsensical. The probability is that they would not have a massive effect on the Members of this House but they would meet the observations of those who want to see some change. I hope that they might be considered in legislation before the end of this Parliament.
	However, I think it would be wise if we looked at the wider functions of this House and its representative nature in a much broader context. We are, after all,
	facing the possibility of a restructuring of the governance of the United Kingdom. We face the possibility of Scotland becoming independent, and it seems to me that we are tinkering at the margins if we become obsessed about this House before we have understood how the nations of the United Kingdom are to be governed. If there are changes, they might have to be reflected in the structure of the second Chamber.
	Consequently, I repeat what I indicated not very long ago in a debate in this House: I think that it would be wise to establish a convention on the future governance of the United Kingdom. That should not be done in a hurry; it should be deliberated upon and attract input from the citizenry of this country so that they can sense that what is being done is based on a consensual decision with the backing of the majority. I do not believe that including reform of the House of Lords in a manifesto will necessarily give that kind of legitimacy. Manifestos list dozens of policies, and what moves people’s minds in elections is not necessarily the small print of manifestos. The structure of our governance is so important that it needs to be considered not in an election period of three, four or five weeks but in a wider context involving expertise and the general will of the British people.
	I hope that before the Scottish independence referendum an announcement might be made that such a convention will be established; otherwise, as I have said before, the Scots might think that there are only two choices—independence or the status quo. However, it would also have a much wider impact on the thinking about the effectiveness of our governance.

Baroness Hayman: My Lords, I join in congratulating the noble Lord, Lord Norton of Louth, on introducing this debate with his usual clarity and intellectual analysis, and on his passionate commitment to this House and the way in which it does its job. It is a commitment shared by all those who have spoken, most notably the noble Lord, Lord Maclennan, who enjoined us to look at the quality of the work that we do rather than having an obsession with size.
	Size does matter, actually. Political balance matters, and the balance between the political appointees and the independent appointees matters. It matters because the function of a second Chamber, particularly one like ours that is not elected directly, is to ask the directly elected Chamber where power resides to think again. That is a very important responsibility of this House, and it is important that the House can discharge that responsibility, not least when, as we know because of timetabling in another place, much legislation comes to this House without having been scrutinised.
	The role of this House is not to overturn or to have the final say, but it is very important that it should be possible for a Government to be defeated in this House so that the other place can have second thoughts—or sometimes first thoughts, because it has not looked at the legislation at all. It is imperative to safeguard that. The quality of the work that we do is not essentially posited on the size of the House. We all agree that we probably need a larger House than we might think at first glance, because of the part-time
	nature and the quality that is added to our work by the fact that people have interaction with the outside world.
	When I joined the House in the Session 1996-97, the absolute membership was 1,204 and the daily average attendance was 381. In the previous Session, 2012-13, the absolute membership of the House was 810 and the average daily attendance was 484. Where was the decision taken that we needed a 25% increase in average attendance to improve the quality of the work that we were doing? This has happened. It has happened because of some of the political dimensions that the noble Lord, Lord True, spoke of, and without an analysis of the need for it to happen.
	It is really important to stop, take a breath and think about that. I have a question for the Leader of the House. I asked it twice in Written Questions of his predecessor, and never got what I would call a satisfactory Answer. I asked to which of the political parties that fought the previous general election the pledge that the House of Lords should reflect the votes cast in that election applied. It is quite an important question.
	What has been done is that the membership of the House has been changed in line with the two major parties that form the coalition, not by taking a totally proportional view and bringing in minor parties. I do not particularly mind not having the votes cast for the BNP or indeed UKIP at the previous general election represented in membership and appointments to this House, but it is very important that we understand the terms of engagement going forward into the next general election. We need consensus and convention on this. The famous definition of consensus—that it is what the House of Commons votes for—does not do it in this respect. We will not get unanimity on many of these issues, but it is important that they are addressed.
	I welcome the Bill that Dan Byles introduced into another place. It is true that not many criminals will be barred, but it brings disrepute to this House if any people who have committed serious criminal offences can return as Members. It would not make a huge difference to numbers if non-attenders were not allowed to attend. However, some of us with long political histories know that there is danger in having a group of people who may not participate all the time but who have the right and the power to participate in moments of great political crisis. If I have not been clear enough in my message about that, I will say only three words—the poll tax. So it is important that the membership of this House reflects those who are active and participatory.
	I have no desire to introduce mechanistic or arbitrary solutions to this issue. I do not believe in a moratorium on new Members because I also welcome what the new Members have brought to this House and continue to bring. However, we cannot just continue to expand. I sometimes said when I had the honour of representing the House and acting as its ambassador that I sometimes thought the Government believed that the Chamber of the House of Lords was the TARDIS—it got bigger and bigger inside so that it could accommodate whoever came in. It is not quite like that. This is not
	only about having enough seats but about having time to speak in debates—a one-minute limit on speeches—and a whole range of issues.
	I hope that the Leader of the House, with support from the Government—I am not as pessimistic as the noble Lord, Lord Tyler, on this—when Dan Byles’s Bill becomes law, will undertake to have discussions with leaders of the other parties about retirement provisions and how we could make progress on reducing the size of the House in a sensible, constructive way that will not damage our performance. However much we know that 800 is not a bad thing at the moment, the outside world finds it difficult to understand those kinds of numbers and we should do something to reduce them.

The Earl of Caithness: My Lords, a Session of Parliament without a regular debate about ourselves would not be the same. We have become so used to having such debates over the past 15 years, or even longer, and our regular navel gazing has become part of each Session. I therefore thank my noble friend Lord Norton of Louth for introducing the debate.
	The noble Lord, Lord Kakkar, hit the nail on the head when he said, “What is the purpose of a second Chamber?”. Once you have the role of second Chamber, you can then decide how that is best fulfilled, and on its numbers. However, deciding on a role for the second Chamber depends on the role of the first Chamber—in our case, the House of Commons. Despite joining Europe and many powers going to Europe, both Houses have evolved to the state they are now in, and perhaps we ought to stand back and say what we really want from them.
	It was interesting and a matter of concern to read that, despite the low level of scrutiny of legislation in another place, the number of amendments tabled in your Lordships’ House, and the number agreed, have gone down. The statistics on this from the Library are interesting. In the period 2005-06 to 2010, the number of amendments tabled in this House dropped from around 10,000 to about 2,000. We pat ourselves on the back and say that we are doing a good job, but I do not know whether we are. When I cast my mind back 44 years to when I first came here to the job that that House was doing then, and a Conservative or whatever Government of the day were defeated, just as today’s Government are defeated, I wonder whether we are doing a better job than our predecessors. There are more people and we are doing more work, but is it better? I am not in a position to answer.
	My noble friend Lord Maclennan made a good point when he mentioned the work of the European Union Committee sub-committees. When he said that, I immediately thought of two reports, one of which was on the common fisheries policy. That report had a marked effect on the thinking of the Commission in Brussels, because most of the ideas set out in it were taken up and brought forward as proposals in EC legislation. The other report is one that I have been involved with: the report of Sub-Committee A on the financial transaction tax. It made our Government think again and led to them submitting a legal objection
	to the Commission. Those are two instances where our reports have had a marked effect, but I wonder whether in the generality, despite some extremely good work, our reports are getting the attention they deserve.
	On the question of our work, another statistic that has both surprised and alarmed me is the number of Written Questions that we are putting down. The rate is on an almost perpendicular upward trend at the moment. Each Written Question costs a lot of money to answer and takes up a lot of civil servants’ time. Why has there been this sudden trend? The population of the House has not grown markedly over the past couple of years, and yet the number of Written Questions has, and that is a potential cause for concern.
	My noble friend Lord True mentioned the age profile, and of course he is absolutely right. I agree entirely that it is very good that an older House up here complements the young enthusiasm of the Commons, but a closer look at the statistics shows that we now have only 31 Members under the age of 50. I think that some of us regret the passing of the hereditary Peers in 1999, because at least a lot of young people were brought in, which added to the balance of the House. At the same time, 24 Members of the House are over the age of 90, and 13 of them are active. The great majority of the House, something like 66%, is aged between 60 and 80, and the average age is around 70. I cannot think of any job or organisation in the world that I could have been a member of for 44 years and still be under the average age, and I am extremely grateful that I am still here and able to participate. But perhaps it is something that we ought to contemplate.
	As long as we have the Prime Minister’s prerogative to create peerages, we are never going to solve the problem of numbers. I do not think that past Prime Ministers, such as Prime Minister Blair and Prime Minister Brown, did this House any good, and in fact I am not certain that my Prime Minister and the Leader of the Liberal Democrat party and Deputy Prime Minister, Mr Clegg, have done us any good with the number of people they have appointed. That has changed the House quite markedly. The noble Baroness, Lady Hayman, said that the House ought to be politically balanced. To an extent that may be so, but if every five years there is a marked swing in another place, a whole lot of new Peers will have to be created here—

Baroness Hayman: I apologise for taking up time in a timed debate, but I did not intend to say that I thought that the House should be politically balanced. I said that I thought there should be some agreement on the parameters of political balance, and on the balance between political appointees and non-political appointees.

The Earl of Caithness: My Lords, I am grateful to the noble Baroness for that clarification. However, if one follows the argument that one needs political balance, if there is a dramatic swing in 2015, more Peers will have to be created to reflect that balance. If there is a sudden drop in support for the Labour Party—which I fully anticipate—I am sure that some Labour Peers would want to resign from here in order to get that balance, rather than see the creation of new Conservative Peers.
	The suspension of the succession of hereditary Peers has been raised, but that would not beeffective. Any Government—particularly a Conservative Government, because our party has the most hereditary Peers—would just appoint life Peers, most of whom would be older than the current hereditaries, or the current possible successors to those hereditaries, so that would not be very good.
	I have a couple of suggestions for my noble friend on the Front Bench. Why not create the equivalent of the Irish peerage? We could offer people a peerage, but no right to sit in this House. That would be a good thing. Then there are the ex-MPs, who make up 22.7% of this House. I welcome them. Most are Labour, and have kept this House even though they were all part of a party that wanted to abolish it. However, perhaps there ought to be a five-year moratorium after someone has been an MP before they are offered an active peerage in this House.

Lord Dykes: My Lords, I am sure noble Lords are all grateful for the explanation of the age paradox from the noble Earl, Lord Caithness. I hope I am correct in saying that the main speaker in the debate so far who has not been worried about size in the future was the noble Lord, Lord True, whose points I can understand. The general sense of the debate so far, as far as I can tell, is that size is a problem and that something needs to be done.
	The Bill from Dan Byles MP in another place has 11 very able and senior members of all the parties acting as sponsors, including some of course who are also in favour of an elected House of Lords. When it comes to this House, it will have a very tight timetable for us as well, as it will follow the European Union (Referendum) Bill, with its equally stringent timetable. I hope that there will be ample time for discussion. The Dan Byles Bill is really the intellectual and psychological follower of the four earlier Steel Bills—which were, incidentally, ignored by two Governments not just by one. If we add Peers who do not attend during a Session and do not apply for a leave of absence under the Standing Orders, ceasing membership would be an important part of any future elements.
	All the way through the efforts that I have detected to make rational progress on the successive Steel Bills, as I will call them, the hope was entertained that the Government of the day would pick up the Bill and make it central government business. There is still an opportunity for that and I think more and more Peers would support that aspiration. Although the three or four measures for reducing individual membership seem to be very modest and at the margin, the practical effect would be quite rapid over time. It is crazy that we contemplate the fact that this Chamber is literally too large with some calmness at the moment—although I hope not too much. It is around the size of the entire European Parliament, which represents 28 member states. The latest text of the Bill, which began its Second Reading before June 2010, in February 2009, added the helpful provision of non-attendance producing disqualification.
	Whatever the fate of the fundamentalist parts of these ideas—mostly having elected Members in the future—in the Joint Committee’s plans published at the end of April 2012, the stage has now been decisively and helpfully set to bring about a reduction in numbers if this legislation becomes government business. To my mind, the Commons would never have accepted the election plan. Although there was a huge majority on Second Reading of the fundamental reform Bill, ironically it began to unravel almost immediately after that. Many members of the leading coalition party refused to ordain new laws which they feared would inevitably lead to the upper House challenging their unique powers and legislative primacy. Eventually, beyond the inaugural Session of a new elected House of Lords, they would presumably want to turn themselves into an ambitious senate in no time at all. There were articles about this saying that there would eventually be senators in the House of Lords demanding office facilities and staff expenses of £1 million per office to deal with all the correspondence and work that would now arise as a result of being elected. The House will indeed be large and expensive if attendance claims rise, even if, as we hope, they rise because of expanding membership rather than individual claims as the number of days goes down.
	This has been a long, drawn-out, painful episode of various bits and pieces. The provisions of the Constitutional Reform and Governance Bill of July 2009 that covered the suspension, resignation and expulsion of Members were taken out of the text in the final version; hence the reintroduction pledge by my noble friend Lord Steel. He repeated his view then that the Bill did not deal with future composition. The Bill also provided for the end of the hereditary Peers’ by-elections, which were described as farcical by some, but that section was later taken out.
	All these matters lead to the fact that a good number of non-Tory Peers have always agreed with Tory traditionalists in both Houses that an elected senatorial peerage would be bound to challenge the superior powers of the other place. In the mean time, the size problem has acquired the ominous characteristic of an almost grotesque situation, with Parliament being unable to make rational progress on these matters, in a perverse and ridiculous setting, which gives rise to very great public dismay. The most recent intake of nominated Peers, we remember, had to be announced deliberately after the House rose for the summer holidays. There was an outcry in the press and it is very difficult for the public to accept the seeming illogicality and absurdity of yet another large increase.
	It gives me no pleasure to say these things about the financial side of it but the reality that we now face is that the incidence and weight of the Tory party’s very large tribe of donor Peers gives much offence to the public—I am sorry to say that but I have to—especially among those who happen to believe that the House of Lords does a pretty good job as a revising and improving Chamber, which I feel is definitely the case. Of course, all parties have donors so I will avoid smugness. I will only mention in passing that we Liberal Democrats have donors only from time to time; they do not come along in serried ranks. Labour, too, has a good crop nowadays, which only underlines one of the great
	weaknesses in British politics, which is the failure in recent times, mainly in the Commons, to reach consensus on vital factors affecting Parliament as a whole.
	We should think of the damage that has been done by the terrible imbroglio over the MPs’ expenses saga and our own expenses saga, when the Times took the lead because it was annoyed that the Telegraph had the priority with the previous articles, and the fact that there was not any consensus between the party leaders. I understand the pressures but the competition between political parties is now so excessive that no party can admit that it believes in anything that the other parties are suggesting—apart from the coalition parties, of course. The pressure is very strong.
	We should work to persuade people in the Commons to listen to this and to revive the suggestion of £5,000 maximum personal donations with, if necessary, further restrained sums of public money for essential party infrastructure spending. The opposition leader’s offer to break the trade union membership nexus is a concrete, positive step, which might help to get the parties around the table soon, but this has been going on for an awfully long time and it is about time they reached agreement on this matter.
	The only time when an independent recommendation for a salary increase for MPs was accepted was when Edward Heath was Prime Minister in 1972. All the others were blocked, once again because of the lack of consensus. This is doing damage because these are parliamentary matters rather than matters of different policies and competition between parties on policy. If we can separate those two things out and see how the Dan Byles text makes progress in our House and goes back to the Commons in unamended or amended form, we can begin to see the beginnings of common sense in size reduction. I hope that the Leader of the House will be able to give us some guidance today.

Lord Cormack: My Lords, it is about 12 years since my noble friend Lord Norton and I formed a group to which many of your Lordships come quite often: the Campaign for an Effective Second Chamber. Over the years, my noble friend has with assiduity acted as our convenor, and I have chaired the sessions, and we have had some fascinating discussions. We are all grateful to my noble friend for the clear, forensic way in which he introduced the debate today.
	Our group was formed because we believed in a second Chamber that was appointed and not elected and therefore did not challenge the unambiguous democratic mandate of another place. I still strongly believe that there is a real place for such a second Chamber and I believe that we have demonstrated that in recent years. We all know those wonderful lines from “Iolanthe”, looking back to previous eras:
	“The House of Peers, throughout the war
	Did nothing in particular And did it very well”.
	Well, we have over the past 12 years and more done quite a lot of particular things and done them very well. We live in a time, as has already been referred to, where much legislation comes to us not having been discussed at all in another place. The skill with which
	the experts in this place analyse and scrutinise is of incalculable importance to the people of this country.
	That is why it is important that the reputation of this House should stand high. I believe that it does. The right reverend Prelate the Bishop of Leicester made an interesting speech, but he referred to our being dysfunctional in some respects. I do not think that we are. There are of course dangers, and my noble friend Lord Norton of Louth and the noble Baroness, Lady Hayman, and others have been right to refer to them, but my noble friend Lord True was also right to refer us to an era when only 12 or 15 Peers were appointed each year. The answer to the problem of size—and it is a problem—lies in three things. The first is an abandonment of any idea of a ratio to the last general election; the second is a degree of self-restraint; and the third is underlining in the appointments that are made the fact that this is indeed a House of expertise.
	I welcome as others have done those who have recently joined our ranks. It would be invidious for me to pick out a whole list of names, but I give just four to your Lordships to illustrate the importance of bringing in fresh blood: on these Benches, the noble Baroness, Lady Neville-Rolfe, who has remarkable experience in commerce; my noble friend Lord Bamford, who has achieved so much in industry; and from the Cross Benches, the noble Baroness, Lady Lane-Fox, who is already making a real mark in this House and who knows more about the technological revolution than most of the rest of us put together. And then one thinks of the former Governor of the Bank of England, the noble Lord, Lord King, to whom I was speaking yesterday. The appointment of people such as this enriches this Chamber and therefore enriches the counsels of the nation. It is very important that we should continue to do that.
	But there must be an abandonment of the ratio idea and there must be a paring-down of the number of Peers who are appointed each year. As someone earlier pointed out, sadly, we lose 12 or 15 Members each year on average. If the number of annual appointments was of that order, we would certainly not be inflating the size of the House. My noble friend Lord Norton in his very admirable speech referred, as did the noble Baroness, Lady Hayman, to the average attendance now being 484 per day, but we must bear in mind that they are not the same 484 people day after day. If we are to draw upon a wide range of experience and deep reservoir of talent, we must not be over-worried about numbers, although we are right to be concerned. Concern is something we all share. We are concerned about the reputation of this House.
	I very much hope that Mr Dan Byles’s Bill will complete its passage through another place, come to this House and be given an expeditious passage. In effect, it was passed here last year. It can then get on to the statute book with the Government’s support and it is right that it should. But I will just make one specific request and one suggestion to my noble friend the Leader of the House, fully appreciating that he cannot comment in detail on the first point that I will put to him. When people are being appointed to this House, let us bear in mind the need for expertise. Let us ask
	ourselves the question “Do they also serve who only come to vote?”. To appoint people to this House who play really no part in our proceedings and merely vote in the Lobbies is not serving the nation or Parliament as it should.
	Apart from that comment, I put two suggestions to my noble friend the Leader of the House. The noble Baroness, Lady Hayman, was an admirable Lord Speaker of this House. In her just as admirable speech, she suggested that party leaders should try to get together. I agree with that but something else should be done. I say this with a degree of hesitation and reservation because I do not want to see a proliferation of committees, but in the last year of this Parliament there is a real case for establishing a Select Committee of this House to consider the sort of suggestions and comments that have been made this afternoon and to try to draw up what might be a blueprint for the House of Lords as we move through the 21st century.
	There will always be a need for a place like this. There will always be a need for men and women of expertise and experience to debate the laws of the land. There will always be a need for those set-piece debates—we do not have enough of them—such as we had on Syria where the enormous and varied experience can bring to the counsels of the nation a true balance and some real worth.

Lord Hunt of Kings Heath: My Lords, I, too, welcome the debate and particularly thank the noble Lord, Lord Norton. We are indeed fortunate in having such a constitutional expert as a Member of your Lordships’ House. As the noble Lord, Lord Cormack, said, while I do not always agree with all the emanations from the group that the noble Lord, Lord Cormack, chairs, there is no doubt that it has added very much to our knowledge and enabled us to debate some of the very important issues that we must when it comes to reform of your Lordships’ House.
	I tend to agree with the key point made at the beginning by the noble Lord, Lord Norton, that your Lordships’ House has grown, is growing and ought to be reduced. I think I share the following point with a number of noble Lords: while the size of the House is important, much more crucial is the question as to whether it is effective in acting as a check on the Executive and as a revising Chamber, and in adding to the effectiveness more generally of parliamentary scrutiny.
	As ever in your Lordships’ debates, most noble Lords who asked that question have tended to come to a view in the affirmative. Of course, we all understand the strengths of your Lordships’ House but we ought to examine its effectiveness in the context of the impact of coalition government. We have a situation where the coalition parties in your Lordships’ House have a political majority over the opposition. I would argue that that threatens the effectiveness of the House. I know that the noble Lord, Lord Hill, when he comes to wind up will refer to the defeats that his Government have suffered here but the rate of defeat is much less compared to the period of 1997 to 2010. I know that it is a little early to draw conclusions from the impact of the latest appointments to your Lordships’ House but,
	certainly from this side of the House, it would appear that the Government are able to win votes which in normal terms they would not have done. The problem with that is that if a Government are no longer able to be defeated in your Lordships’ House on a regular basis, this can no longer call itself a revising Chamber. We need to consider that very carefully.
	I also agree with the noble Lord, Lord Maclennan, on substantive reform in the sense that we surely need to see the outcome of the referendum in Scotland and any constitutional fallout from it. Substantive reform of your Lordships’ House cannot be considered in isolation from either wider constitutional issues or the impact on the primacy of the Commons. At the risk of tempting the noble Lord, Lord Tyler, to get up and remind me of my past sins, in the joint working group chaired by my right honourable friend Jack Straw—the noble Lord is right that I served on that, with its cross-party talks—there was a failure, which the Deputy Prime Minister repeated, even to contemplate how an elected second Chamber fits with a House of Commons when there is a pretty consensual view that we wish to retain its primacy. That failure, in my view, led to the failure of Mr Clegg’s Bill. In the end, that was a failure; it was quite clear from what was happening in the other place that it did not stand an earthly chance of getting through.
	The question of size was discussed by the committee of the noble Lord, Lord Hunt, on which I had the honour to sit. It came up with a proposal to allow Members of your Lordships’ House to retire and it has been enormously successful, as noble Lords will know. I think we have not quite yet reached double figures but one is ever hopeful. The Hunt committee said that the problem with an ever increasing size is that it risks the reputation of the House, that it probably makes conducting business more difficult and that the effect of the additional Members on the resources of the House and its ability to do its job would also be adversely affected.
	We are right to ask the noble Lord, Lord Hill, the Leader of the House, what the Government’s intention is with regard to any further appointments between now and the general election. Are the Government intent on implementing what was in the coalition agreement or have they stood back from that commitment? Does the Leader of the House accept that the general view of Members of your Lordships’ House is that there should be very few appointments between now and the general election? Does he agree with the noble Lord, Lord Norton, that there ought to be a cap on membership, and will he institute cross-party discussions as suggested by the noble Lord, Lord Tyler? The noble Lord, Lord Cormack, suggested that there might be a Select Committee of your Lordships’ House and there is an argument in favour of the political parties and the Cross-Benchers discussing these matters in a small group or in a more formal Select Committee. It would surely be useful, in the run-up to the election, for there to be some discussions across the House.
	Does the noble Lord, Lord Hill, agree that if the size of the House is limited, in the end there have to be questions as to how to achieve a party balance? It is
	not possible to have a cap without some general agreement on how the parties should be balanced in your Lordships’ House. That would also need to reflect on Cross-Bencher representation and on the number of Bishops who should remain in your Lordships’ House in the event of such agreement.
	Does the noble Lord, Lord Hill, take the point raised by the right reverend Prelate the Bishop of Leicester that if we see women bishops, as many of us devoutly hope, will there be a way of accelerating them to membership of your Lordships’ House? I am not sure whether this is a question of law or of practice, but no doubt the noble Lord will be able to inform us of that.
	My next point is one that was raised by the noble Lord, Lord Norton: what advice would the noble Lord, Lord Hill, give to an incoming Government in 2015 faced with a political majority against it? How many noble Lords does he think an incoming Government ought to appoint if we are to keep to the mantra that he has stuck to over the past three and a half years? I must say that I rather warmed to the reference by the noble Lord, Lord True, to Tony Benn’s 1,000 Labour Peers; that has a certain ring to it.
	I want to ask the noble Lord, Lord Hill, about time and the question of whether a fair wind will be given to the noble Baroness, Lady Hayman, on the assumption that she takes through Mr Dan Byles’s Bill. I was rather shocked by the suggestion from the noble Lord, Lord Tyler, that the time taken for the European Union (Referendum) Bill might crowd out Mr Byles’s Bill. I do not think that that would be the will of the House; I think that the will of the House would be that the noble Baroness should be given a fair wind.
	Lastly, I want to ask the noble Lord, Lord Hill, about finance. I have been riveted by the debate on the recommendations of IPSA regarding MPs’ pay, but I noted the Prime Minister’s comment that he wished to see the cost of politics reduced. Although I accept that the costs of your Lordships’ House are rather modest compared with the other place, I wondered whether the noble Lord thinks that the Prime Minister making all these appointments is consistent with wishing to reduce the actual amount that our politics cost us.

Lord Hill of Oareford: My Lords, earlier today this House was debating death, and I know that the noble Baroness, Lady Hayman, has spoken in both debates. In his choice of debate, my noble friend Lord Norton of Louth has brought us forward a few years chronologically, perhaps to the transit lounge from the departure lounge.
	This has been a good debate and I know that we are grateful to my noble friend for giving us the opportunity to raise some extremely important issues. As always, I am reminded of how much noble Lords know, and how well they appear to know every twist and turn of the history of the composition of this House.
	I start with a point that I do not believe is contentious—one that my noble friend Lord Maclennan and others made—which is that we perform a vital role and that we do so very well. I start with that point
	because sometimes, when we discuss our internal matters, we can be in danger of losing that bigger picture. I believe that our scrutiny of primary legislation is as thorough and as expert as ever; I agree very much with my noble friend Lord Cormack on that. Having had the dubious pleasure of taking legislation through your Lordships’ House, I can speak from experience about the rigour of that scrutiny. We may be polite but we are relentless.
	The contrast between scrutiny in this House and scrutiny down the other end is remarkable, as a number of noble Lords have said, and I see no sign of any diminution in our performance of that most fundamental role. I agree with the noble Baroness, Lady Hayman, on the importance of being able to defeat the Government—a point made also by the noble Lord, Lord Hunt of Kings Heath. That is what we have in this House. However, we need the addition of new expertise and new vigour from time to time to help us to carry out that role of scrutiny.
	Unlike in the other place, all Members in this House can take part in all stages of legislation. All noble Lords can table amendments and, because there is no process of selection, they are guaranteed a debate on each of those amendments, should they wish to have one. Less visible, but, I think, of great importance is the work that we undertake on secondary legislation. Our House gives more time than the other place to scrutinising these rather unglamorous yet often highly significant pieces of legislation—and, again, in this House, all Members can participate fully in all stages of that scrutiny.
	Through Oral and Written Questions, Questions for Short Debate and longer debates such as this, the House holds the Government to account, as it does through the work of our Select Committees, involving large numbers of your Lordships in detailed investigations of different areas of government policy. In this context, I thought that the important points made by the noble Lord, Lord Kakkar, were very pertinent. I know how much we all welcome his appointment as chairman of the House of Lords Appointment Commission.
	I am reminding us of the work that we do not to give us a self-congratulatory pat on the back, although sometimes that is not unknown in your Lordships’ House, but to make the important point that not only has the work of the House not been damaged by increased attendance, it has in many respects continued to improve year on year—and long may that continue.
	We have talked about numbers this afternoon, and there has been talk, including by the right reverend Prelate the Bishop of Leicester and my noble friend Lord Dykes, about packing the House and overcrowding. I listened to the figures adduced very carefully, but there are other figures. It is the case that the list of new Peers announced in August was the first political list for three years. I am afraid that I have to disagree strongly with the comments made in that context by my noble friend Lord Dykes. There are only 24 more eligible Members in the four main groups than there were in 2007, and I am not aware that in 2007 people were making the point that there were too many Peers in the House. There have certainly been new Peers
	created since 2010, but around 100 Members have sadly died or taken leave of absence over the same period. I argue that the figures also show that my right honourable friend the Prime Minister has been even-handed in his appointments. For example, 39 Labour Peers were appointed in his first year compared with 47 Conservatives, as my noble friend Lord True reminded us.
	I think there has been general acceptance this afternoon that we need to refresh our ranks from time to time, rather than freezing the membership at a particular point in time, so that the expertise and experience on which the House relies for its good name can be kept up to date. In fact, I think the real issue is not so much the absolute number of those entitled to vote—a point that has already been made—which has been more constant over the past five years than many people recognise, but the higher level of attendance.
	I accept that average attendance has been increasing—it was about 480 in the previous Session—but that is the figure we should concentrate on, not the figures we sometimes read about which do not relate to our day-to-day experience. I recognise that higher attendance means that the House will sometimes be crowded on popular occasions, but it is important to remember that we should not overstate the problem. There is plenty of space in the Chamber and in Grand Committee during the great majority of our business, particularly legislation, and the same is true of debate—there are some empty spaces here this afternoon.
	Members generally have time to speak. There has been some reference today to Members having only one minute to speak. They had an average of nearly six minutes in time-limited QSDs in the previous Session, and more than nine minutes in balloted debates. Even during Oral Questions, which I know, probably more than anyone, is a particularly busy time, we have a wide range of participants. Work done by the Clerk of the Parliaments earlier this year showed that in the first quarter, 288 noble Lords asked one or more supplementary questions during Oral Questions. Because more Members are attending, one of my priorities has been to increase the scope for Back-Bench Members to take part in the work of the House. Perhaps most noticeably, we have almost doubled the amount of time we make available for Back-Bench QSDs, and the results have been dramatic. The only noble Lords yet to be offered time for their QSDs are those who have already had a QSD this Session.
	Indeed, the supply of time is sometimes exceeding demand. For example, this Tuesday evening, the House rose at 6.20 pm because the Whips’ Office was unable to find anyone to ask a QSD or put forward a Select Committee report for debate after the Second Reading. We have also introduced a new slot in prime time for a weekly topical QSD, which Back-Benchers had said that they wanted. We supported the creation of additional Select Committees, especially ad hoc committees and post-legislative scrutiny committees, so that more noble Lords would have the opportunity to participate in that important aspect of our work.
	I recognise that participation in proceedings is not the only aspect of the issue raised by my noble friend Lord Norton of Louth. Some noble Lords have suggested
	that the facilities in the House are not able to cope with the current level of attendance. While that is a matter for the Chairman of Committees, we should not overstate the extent of the problem. We know that there is plenty of spare capacity in our restaurants, for example; indeed, the problem we have is too few people eating in them rather than too many. While desk space for Members has always been at a premium, we currently have more accommodation than before, thanks to the acquisition of Millbank House. Figures presented to the House Committee earlier this year showed that there were desks which had not yet been allocated to individual Members. In terms of research capacity, something about which Members are concerned, noble Lords may like to know that the number of Library staff has increased from 31.5 full-time equivalents in 2007 to 38.5 today.
	On the cost of the House—and, indeed, the cost of politics, which was raised by a number of noble Lords, including my noble friend Lord Norton of Louth and the noble Lord, Lord Hunt of Kings Heath—the cost of the House of Lords has not gone up: it has gone down. The resource budget for the current financial year, including the costs of Members’ allowances and expenses, is £4 million lower than it was in 2010-11. That is equivalent to a real-terms cut of 15%, which is a considerable achievement by the administration, on which we would all want to congratulate them.
	There obviously is a cost for new Peers, and I recognise that. My noble friend Lord Norton asked me what it was. It is hard to predict precisely because, of course, it depends on attendance and on how much an individual Member will claim. On future numbers, it is clearly hard for me to predict what any future Government might do on appointments. The noble Lord, Lord Hunt of Kings Heath asked me whether I accepted that the mood of the House was that it would not welcome any more new Peers before the next general election. Obviously, I am very aware of the mood of the House in that regard.
	A number of suggestions were made by noble Lords as to ways forward. Many of them would require legislation to achieve. I will briefly update the House. We have had a bit of discussion about what we are calling the Byles Bill. As my noble friend Lord Tyler reminded us, there was a government proposal for an elected House that would have dealt completely with my noble friend Lord Norton’s question about size by reducing the House to around 450 Members. However, following the failure of that Bill to emerge from the other place, the Government have made it clear that they do not intend to bring forward any further relevant legislation for the remainder of this Parliament.
	There has, however, I am glad to say, been progress on some other issues which have been raised today, particularly in connection with retirement. Here, I share the greater optimism of the noble Baroness, Lady Hayman, rather than the pessimism of my noble friend Lord Tyler. The House of Lords Reform (No. 2) Bill, more commonly known as the Byles Bill—but which, down at our end of the building, we still rightly think of as the Steel Bill—has been making some progress. I know that we are all grateful to my noble friend Lord Steel of Aikwood for his work over many years in pursuing that objective.
	The Byles Bill would make a number of modest but, I think, sensible changes. It would allow permanent retirement and resignation and the exclusion of non-attenders, and would expel those convicted of a serious criminal offence. I am sure that the House would value having a formal system whereby Members could resign or retire with dignity. I should, however, say for the record that I do not believe—I know that this view is shared by the leaders of the party groups and the Convenor, as it happens—that retirement with dignity is compatible with any system of financial incentives to encourage that retirement. This point was also made by my noble friend Lord True.
	I know that in the past some noble Lords have raised with me what possible rationale there could be for opposing some kind of payment on retirement. I have two main reasons for opposing it, which I think are shared by the other group leaders. The first reason is one of principle and the second is practical. The issue of principle is, quite simply, that it is an honour to be here, not a job; noble Lords are given an allowance, not a salary. If noble Lords decide that it is time to retire, they should do so, and if they are no longer coming, they should not require an allowance.
	The second reason is a practical one to do with the reputation of the House, about which we have heard a lot this afternoon. I think that the outside world would take great exception to the idea that a Peer who has already had the honour of serving in your Lordships’ House would receive a lump-sum payment from the taxpayer for stopping doing so. I hope very much that the Government’s support for the Byles Bill will help it complete its passage through the other place, and I look forward to its progression through this House and, in due course, on to the statute book.
	The House could take other measures short of legislation, some of which have been set out in the recent report by the Commons Political and Constitutional Reform Committee and in a paper by the Clerk of the Parliaments. I am not able to pre-empt the Government’s response to the committee’s report. However, some of the issues that were raised in that report are matters for this House alone to determine. For example, the report suggested that retirement from this House could be marked in a more formal way, both in the Chamber and outside. Another proposal was that the leave of absence scheme could be further strengthened to build on the success of the recently introduced practice of the Clerk of the Parliaments inviting infrequent attendees, at the beginning of each Session, to take leave of absence. I am very happy to see whether we can make progress on those points. I welcome any suggestions from noble Lords on what an enhanced retirement ceremony might look like, and on how the leave of absence scheme could be further improved.
	On specific points that have been raised with me, my noble friend Lord Cormack suggested the establishment of a Select Committee or some other group to consider possible ways forward. As I am sure he knows, I am always happy to talk to him and other noble Lords. Our challenge is not that there is a shortage of suggestions as to what we might do—we know what they all are and we have discussed them many times. Our challenge is to secure political agreement,
	not so much in this House but with Members at the other end, and to make progress with them.
	The noble Lord, Lord Hunt of Kings Heath, talked about balance in the House—a point I referred to before. It is the case that together, the two coalition parties add up to about 41% of the House. We all know that there are a range of issues where a combination of opinion from the Cross-Benches, Labour and some coalition Peers—on both sides of the coalition—can readily defeat the Government and cause them to think again. A good example of that, which I am sure the noble Lord has been involved with, is the issue that I hope we will try to resolve next week around the lobbying and transparency Bill.
	On the question raised by the noble Baroness, Lady Hayman, about a proportion of Peers from the minority parties, I am not convinced that I will be able to give her an answer that she would consider satisfactory, any more than my predecessor did. The best I can say is that that formulation was intended as a general statement of approach rather than a precise mathematical formula. We should not consider it as the latter; that is, in a way, borne out by the practice which the Prime Minister himself has observed since the general election. If the precise formula had been followed, many more Peers from the coalition parties would be joining your Lordships’ House.
	My noble friend Lord Caithness asked about the possibility of creating a different kind of peerage—a non-sitting peerage. To do that, we would have to legislate to create a new and different kind of life peerage. Another approach, I suppose, would be to restart the practice of creating hereditary peerages, which would not entitle holders to membership of the House. But I am not sure that I would be able to make much progress with that suggestion.
	My noble friend Lord Maclennan raised a point about a constitutional convention. I take the point about the importance of the referendum in Scotland. My view, which I know is that of many noble Lords, is that our focus should be on making sure that that referendum is won by those who want to keep the United Kingdom united and the union together. So I am not keen on crossing bridges which I do not believe we will need to cross. It is also the case, on the narrower aspect of the future of your Lordships’ House, that the three main parties in their last manifestos reached a broad consensus on their preference, which was for an elected House.
	A lot of important points have been raised. We are very grateful to my noble friend Lord Norton for giving us the opportunity to consider them again. Some steps we have taken; we all look forward to the Byles Bill coming next year. I know that we will come back to these issues in future, including the one about women Bishops raised by the right reverend Prelate the Bishop of Leicester. I know that the Government will do what they can to help the church take forward its desire to see women bishops in your Lordships’ House. But pending more fundamental reform that would decisively address the issues that have been raised, we should focus on the important job with which we are all tasked, and which we are performing very well. We are a House that has cut the cost of running itself and
	has increased opportunities for Back-Benchers to scrutinise the Government—and, above all, we are a House that continues to do its core job of scrutinising legislation rigorously, purposefully and effectively.

Lord Norton of Louth: My Lords, I am grateful to all those who have spoken, and to my noble friend the Leader of the House in particular for replying to the debate. I also appreciate greatly the contribution of the noble Baroness, Lady Hayman, who is speaking in her third debate today. I thought that she encapsulated the point extremely well—size matters. Many of the speeches demonstrated concerns felt in different parts of the House.
	This House clearly performs valuable functions; I do not think that the functions are in doubt. Nor is the fact that the House fulfils them effectively. I think that we do a very good job indeed; that is the great merit of the House. We tend to do the work extremely well, and I think that we should proclaim that fact. But my point is that the growing size of the House does not facilitate us in fulfilling those functions effectively. As I have said, it is only one aspect that we need to address, but it is an important one.
	I say to my noble friend Lord Caithness that we will continue to have these debates until action is taken. He himself went on to refer to the problem of numbers, and came up with one or two ideas, one of which I would fully endorse—it is something that I have supported for some time. We need to think through the implications of the fact that we continue to grow. It is that dynamic element that my noble friend Lord True did not really address. Nor, to some extent, did my noble friend Lord Hill. We need to have a clear view as to what we believe is the optimum size of the House—and then, within that, the distribution among the different groupings. As my noble friend Lord Tyler indicated, we have not really had that discussion. That, I think, should be our starting point.
	I endorse the comments of a great many noble Lords who have spoken. I am grateful to my noble friend Lord Hill for what he said, as far as he felt able to go. However, I am sure that he will understand when I say that we will push him to go further. I end with a quote addressed to those who think that things are fine as they are. Burke said:
	“A state without the means of some change is without the means of its own conservation”.
	Motion agreed.

Terrorism Act 2000 (Proscribed Organisations) (Amendment) (No. 2) Order 2013
	 — 
	Motion to Approve

Moved by Lord Taylor of Holbeach
	That the draft order laid before the House on 2 December be approved.
	Relevant document: 15th Report from the Joint Committee on Statutory Instruments.

Lord Taylor of Holbeach: My Lords, the Government are determined to do all that they can to minimise the threat from terrorism to the UK and our interests abroad. Proscription is an important part of the Government’s strategy to tackle terrorist activities. We propose to add Imarat Kavkaz, also known as the Caucasus Emirate, to the list of international terrorist organisations, amending Schedule 2 to the Terrorism Act 2000. This is the 13th proscription order under that Act.
	Having carefully considered all the evidence, the Home Secretary believes that Imarat Kavkaz meets the statutory test for proscription and that it is appropriate to exercise her discretion to proscribe it. Section 3 of the Terrorism Act 2000 provides a power for the Home Secretary to proscribe an organisation if she believes it is currently concerned in terrorism. The Act specifies that an organisation is concerned in terrorism if it: commits or participates in acts of terrorism; prepares for terrorism; promotes or encourages terrorism, including the unlawful glorification of terrorism; or is otherwise concerned in terrorism. If the test is met, the Home Secretary may then exercise her discretion to proscribe the organisation. In considering whether to exercise this discretion, the Home Secretary takes into account a number of factors: the nature and scale of an organisation’s activities; the specific threat that it poses to the United Kingdom; the specific threat that it poses to British nationals overseas; the organisation’s presence in the United Kingdom; and the need to support other members of the international community in tackling terrorism.
	Given the wide-ranging impact of proscription, the Home Secretary exercises her power to proscribe only after a thorough review of the available relevant information and evidence on the organisation. This includes open source material, intelligence material and advice that reflects consultation across government, including with the intelligence and law enforcement agencies. The Home Secretary is supported in her decision-making by the cross-Whitehall proscription review group. Decisions to proscribe are taken with great care by the Home Secretary and it is right that the case for proscribing new organisations must be approved by both Houses.
	Having carefully considered all the evidence, we firmly believe that Imarat Kavkaz is currently concerned in terrorism. Noble Lords will appreciate that I am unable to comment on specific intelligence that leads to any decision to proscribe, but I can provide a brief summary of its activities. Imarat Kavkaz, or the Caucasus Emirate, is a terrorist organisation which seeks a Sharia-based caliphate across the north Caucasus. It regularly uses terrorist tactics and has carried out attacks against Russian state and civilian targets. The organisation claimed responsibility for the January 2011 suicide attack on Domodedovo Airport in Moscow that killed 35, including one British national, and a suicide attack on the Moscow metro in March 2010 that killed 39. Since then, there has been continued activity by Imarat Kavkaz, including renewed threats of activity in Russia made during the summer of 2013. The organisation is designated by the US and listed by the UN under the
	al-Qaeda sanctions regime. Subject to the agreement of this House, the order will come into force on Friday, 13 December.
	In conclusion, I believe it is right that we add Imarat Kavkaz to the list of proscribed organisations under Schedule 2 to the Terrorism Act 2000.

Lord Rosser: The Minister explained the statutory power available to the Home Secretary to proscribe an organisation that she believes is currently concerned in terrorism and the factors that she has to take into account before exercising her discretion. The United States proscribed Imarat Kavkaz in 2011 after it was linked to the two deadly attacks in Moscow to which the Minister referred—namely at the international airport, when 35 people were killed, and in the Moscow metro, in which 39 people were killed. Imarat Kavkaz was formed in late 2007 and is an Islamic militant organisation based in Russia’s north Caucasus. Its stated goal is the liberation from the control of Moscow of what it considers to be Muslim lands. It regularly conducts attacks against Russian security forces and is linked to al-Qaeda.
	We support the order, but I have three points to raise. When the order was discussed in the House of Commons on Tuesday, Diana Johnson MP asked the Minister in the other place about the effects of proscription on the social media, given that Imarat Kavkaz has a number of Facebook pages, and a range of fan pages are directed towards its leader. She asked the Minister to,
	“clarify whether Facebook will be prohibited from hosting such fan pages and allowing people in the United Kingdom to access them once the group is proscribed”.
	The Minister replied:
	“The group’s Facebook page has been referred to the Counter Terrorism Internet Referral Unit, which has responsibility for assessing such issues. If the site is assessed to be illegal, the CTIRU will flag that up with Facebook directly and have it taken down”.—[Official Report, Commons, 10/12/13; cols. 204-05.]
	I appreciate that it is only two days since that question was asked but this order, as the noble Lord said, is due to come into effect tomorrow. What, then, is the position in relation to the group’s Facebook page? This is the 13th order of this kind to be laid. Does the Minister know whether previously proscribed organisations had Facebook or any other social media pages and, if so, whether those pages have been taken down.
	The consequences for a proscribed organisation are considerable for both the organisation and its adherents. It is a criminal offence for a person to belong to or invite support for a proscribed organisation. It is also a criminal offence to arrange a meeting in support of such an organisation, wear clothing or carry articles in public that arouse reasonable suspicion that an individual is a member or supporter. A proscribed organisation or any person affected by the proscription may apply to the Secretary of State for deproscription. If the Secretary of State refuses, the applicant may appeal to the Proscribed Organisations Appeal Commission. First, how many separate applications for deproscription have been made to the Home Secretary since the Terrorism Act 2000 came into force? Secondly, how many appeals have been made to, and been determined by, the Proscribed Organisations Appeal Commission over the same timescale?
	Time-limiting proscription was recommended by the independent reviewer of terrorism legislation, David Anderson QC, who felt that a proscription order should be subject to a review after a fixed period, following which it could be renewed or would lapse. My final question is: what is the Government’s position on David Anderson’s recommendation?

Lord Taylor of Holbeach: My Lords, I hope that I shall be able to answer most of the points raised by the noble Lord, Lord Rosser. I appreciate his support for the order. I strongly believe that Imarat Kavkaz should be added to the list of proscribed organisations.
	The noble Lord asked a number of questions. The first was about the internet and the relationship of this proscription and others to organisations such as YouTube and Facebook. We have been removing illegal terrorist content from the overt space where it is hosted in the UK or overseas and we have good relationships with those in the industry—for example, YouTube and Facebook. To date, the Counter Terrorism Internet Referral Unit, which the noble Lord referred to in commenting on the reply in the Commons, has removed more than 18,000 pieces of illegal material. This particular group’s Facebook page has been referred to the Counter Terrorism Internet Referral Unit. If it is assessed as illegal, the CTIRU will flag this directly with Facebook for removal.
	The noble Lord also asked about applications for deproscription. There has been none since 2009, and indeed there have been no appeals to the POAC. There was one successful appeal in 2007-08 by the PMOI as a result of a judicial review of the case, as the noble Lord will be aware.
	The noble Lord’s last question was about the recommendation made by David Anderson. We obviously take note of that, and indeed matters have been set up. In response to David Anderson, the Home Secretary said that under the current regime any person affected by a proscription can submit a written application to her requesting that she considers the removal of a specified organisation from the list. The Home Secretary is required to determine the application within 90 days. If the Secretary of State agrees to deproscribe an organisation, she will lay an order before Parliament removing it from the list of proscribed organisations. That is subject to the affirmative procedure, as is this order. The Home Secretary’s consideration of these matters following applications from the groups themselves is an effective process. There is a right of appeal and challenge, should the Home Secretary’s decision be negative. Any valid application for deproscription will be considered by the Home Secretary in accordance with the Act. I hope that that helps the noble Lord.

Lord Rosser: Does that response mean that the Government are not looking at going down the road of what I understand to be his recommendation—time-limiting proscription, which would be subject to a review after a fixed period, following which it could renewed or it would lapse? Are the Government not looking to doing that?

Lord Taylor of Holbeach: I have described the position, and I have a note here which helped me to do so. It presents the Home Secretary’s role and the Home
	Office’s view on the best way of dealing with deproscription, subject to application and considered within 90 days. In the event of a negative response there is a right of appeal. That is the current procedure and it would apply to any of the current 14 bodies that have been proscribed through the order.
	Motion agreed.

Legislation: Gender-neutral Language
	 — 
	Question for Short Debate

Lord Scott of Foscote: To ask Her Majesty’s Government what guidance they issue to Parliamentary Counsel with regard to the use of gender-neutral language in the drafting of legislation.

Lord Scott of Foscote: My Lords, on 8 March 2007 the right honourable Jack Straw, the then Leader of the House of Commons, issued a Written Ministerial Statement. The same Statement on the same day was issued by the noble Baroness, Lady Amos, in this House. It related to the use in the drafting of legislation of male pronouns—he, his and him—in context where the individual referred to might change from time to time and might be either a woman or a man. The Statement said:
	“Many believe that this practice”—
	the practice of using male pronouns—
	“tends to reinforce historic gender stereotypes”.
	He went on to say that the Government took the view,
	“that it would be right, where practicable, to avoid this practice in future and, accordingly, Parliamentary Counsel has been asked to adopt gender-neutral drafting. From the beginning of next Session, Government Bills will take a form which achieves gender-neutral drafting so far as it is practicable, at no more than a reasonable cost to brevity or intelligibility”.—[ Official Report , Commons, 8/3/07; col. 146WS.]
	However, as the Statement expressly recognised, the drafting practice of using an apparently gender-specific pronoun to apply both to men and to women had received the imprimatur of Parliament by the enactment of Section 6 of the Interpretation Act 1978. Section 6 of the 1978 Act provides inter alia that:
	“In any Act, unless the contrary intention appears … words importing the masculine gender include the feminine … words importing the feminine gender include the masculine … words in the singular include the plural and words in the plural include the singular”.
	Section 23(1) of the 1978 Act made it clear that Section 6 was applicable not only to Bills and Acts of Parliament but also to statutory instruments.
	It follows from Section 6 that the use in both primary and secondary legislation of apparently gender-specific pronouns is a use of pronouns that are in law, subject of course to the context, gender-neutral. They are no longer in their effect gender-specific. None the less, the obvious purpose of the 8 March 2007 Statement was to discourage the use in legislation of the masculine pronouns—he, him and his—except, of course, where the individual was known and was male.
	There are, however, two objections to the drafting instructions given to government officials pursuant to the 8 March 2007 Statement. The first is an objection
	of principle. The 1978 Act is not an ancient Act that could be regarded as out of date or overtaken by obsolescence. Section 6 represents Parliament’s considered guidance to the use in legislative instruments of gender-related words. The guidance was followed for many years. It avoided ambiguity in the construction of legislative instruments and brought clarity to the identification of the persons to whom the legislative provisions in question were intended to apply.
	It may be that the drafting habit of using in legislation pronouns importing the masculine gender and relying on Section 6 of the Act to enable the pronouns to apply also to persons of the feminine gender as well offends some people’s notions of gender equality. However, it was never more than a habit. That habit could, of course, be adjusted and remedied. If the officials who draft legislative instruments were to be instructed to use from time to time the feminine pronouns—she, her, hers—instead of the masculine pronouns, relying therefore on Section 6 of the 1978 Act to include the masculine, context permitting, why not let Section 6 have the gender-neutralising effect that Parliament intended in enacting the section in question?
	In principle it is inappropriate and, indeed, objectionable for government Ministers to instruct their officials to adopt a drafting practice that simply ignores the provision that Parliament, through legislation, has made for dealing with the perceived problem of gender stereotyping.
	My second objection, however, is bred from my perusal of statutory instruments drafted, I suppose, in pursuance of the instructions given pursuant to the March 2007 statement. I have had the privilege of being for some years a Member of the House’s Secondary Legislation Scrutiny Committee and I hope the House will bear with me if I refer it to the language used in some of the statutory instruments that have recently come before that committee.
	In Statutory Instrument 2013 No. 2828, Regulation 2(2)(b) refers to a child who,
	“by virtue of his or her disability”,
	cannot be expected to share a bedroom. Regulation 3(2)(b) repeats the reference to “his or her disability”. The child in question might of course be a child of either sex, so the use of “his or her” is correct. However, the Explanatory Notes to the statutory instrument explaining that regulation refer instead to “their disability”, but then use “is”, a singular verb form, as the following verb.
	Regulation 4(3) of the same statutory instrument adds a new Regulation 12 to the Universal Credit Regulations 2013. The new Regulation 12(1) states that “A renter”—that is, a singular noun—
	“is entitled to an additional bedroom if they”—
	a plural pronoun—“satisfy”—a plural verb form—“various conditions”. So there is the use of a plural pronoun and verb form, “they satisfy”, after a singular noun, “A renter”. This language reads very oddly, particularly as it is then followed by the use of “are”, a plural verb form.
	Secondly, the Explanatory Memorandum which accompanied Statutory Instrument 2013 No. 2827 and Statutory Instrument 2013 No. 2828 uses in several
	paragraphs the plural pronoun “their” followed either by the plural verb “are”, which in the context of a reference to a single person makes no sense, sometimes followed by the singular verb “is” which, combined with the plural pronoun “their”, also makes no sense.
	Paragraph 7.4 has a sentence beginning,
	“The claimant or their partner is a person”,
	and so on. It then refers to,
	“an adult who is not the claimant’s partner if they are part of the claimant’s Extended Benefit Unit”.
	Paragraph 7.5, says that “a severely disabled child”—that is a single person—
	“who would otherwise be expected to share is not able to do so due to their disability”.
	Paragraph 7.6 refers to,
	“any child who meets the qualifying criteria and is occupying the dwelling as their primary residence”.
	It goes on further in the same paragraph: “a child who requires”—singular verb form—“their”—plural pronoun—“own room”, and so on. It may also be noted that paragraph 7.20 refers to,
	“a child who requires their own bedroom”,
	while paragraph 7.23, when referring to a “child”, says,
	“They are not reasonably able to share … because of their disability”.
	That language, I respectfully suggest, is somewhat absurd.
	Thirdly, the so-called Keeling schedule to SI 2013/2827 and 2013/2828 has a number of oddities. In the references to SI 2006/213, SI 2006/214 and SI 2013/376, the masculine pronouns “he”, “his” and “him” are used, leaving Section 6 of the 1978 Act to extend the references to women. But Schedule 2 to the proposed amendments to SI 2006/213 contains in paragraph 2(4) the following gem:
	“where a son, daughter, step-son or step-daughter of the claimant who is the claimant’s non-dependant ceases”—
	singular verb form—
	“to occupy the dwelling as their”—
	plural pronoun—“home because they become”—plural pronoun and verb form—
	“a member of the armed forces away on operations or subsequently resumes”—
	singular verb form—
	“occupying the dwelling as their home”—
	plural pronoun—
	“on ceasing to be a member of the armed forces away on operations”.
	What may be noted in particular is the use of “they” and “their”, plural pronouns, although the reference is to a single person, and the contrast between “become”, a plural verb form, and “resumes”, a singular verb form, all in the same sentence.
	The next oddity is to be found in amendments made to the housing benefit regulations which provide, in paragraph 13D(2)(12) a definition of “occupiers” that includes in sub-paragraph (b) the following,
	“any member of the armed forces who, (i) is the son … of the claimant,(ii) was the claimant’s non-dependant before they became a member of the armed forces away on operations, and (iii) intends to resume occupying the dwelling as their house when they cease to be a member of the armed forces away on operations”.
	Noble Lords should note the incongruity of including “they become”, a plural verb form, and “intends to resume”, a singular verb form, in the same sentence.
	Another example is the Policing Protocol Order 2011, SI 2011/2744. This statutory instrument refers in a number of places to the “Police and Crime Commissioner”, an individual who may be male or female, and to the “Chief Constable”, who also may be male or female. Paragraph 13 of this statutory instrument states:
	“Each PCC and their respective Chief Constable are established in law as corporations sole”.
	The statutory instrument refers, in several regulations, to the “Chief Constable”, and Regulation 23(f) refers to the “Chief Constable”,
	“planning their policy functions in respect of their force’s … policing responsibilities”.

Lord Ahmad of Wimbledon: If the noble and learned Lord would give way for a moment, this is a time-limited debate and the actual time limit is 10 minutes. As fascinating as his comments are, I think that he has reached the limit. Perhaps he will look to conclude his remarks.

Lord Scott of Foscote: To perorate, if you will. The statutory instrument continues with infelicities to the same extent as those that I have already mentioned.
	The clarity of the language of the protocol is certainly not assisted by the use of grammatically inappropriate plural pronouns coupled with references to a single person. In my opinion, it is a matter of great regret that the instructions given pursuant to the 8 March 2007 statement to those who draft government legislation, were ever given. Statutes and statutory instruments ought not only to be clear and free of ambiguity, but surely ought also to stand as models for the correct use of the English language. To prostitute the English language in pursuit of some goal of gender equality is, I suggest, unacceptable. Moreover, it is quite unnecessary. Section 6 makes all apparently gender-specific pronouns in law gender-neutral, context permitting. In any event, there is no reason other than habit why it should always be male pronouns that are used when both men and women are intended to be referred to. By all means let those who do the drafting sometimes use feminine pronouns, relying on Section 6, where the context admits, to include men, or vice versa.
	The drafting of which I have given examples—and there are more—is not only unacceptable and unnecessary but is, I suggest, an insult to the lovely English language, which to my regret is the only language that I am able to speak or understand. I therefore ask the Government to take steps to put an end to the appalling drafting of which I have given a few examples and to allow Section 6 to have the effect, and to achieve the gender-neutral interpretation of statutory language, that Parliament always intended it to have.

Lord Mackay of Clashfern: My Lords, the noble and learned Lord, Lord Scott of Foscote, has certainly raised an extremely interesting question. I believe that Parliament, in the Interpretation Act, set a
	rule that is perfectly gender neutral in respect of the use of either male or female pronouns.
	It is regrettable that this practice has taken place because statutes and statutory instruments have now become a very fundamental part of our law. I see no reason to suppose that that is likely to reduce to any extent in the future—rather, the opposite seems to be the case. That means that ordinary people, not just the courts and lawyers, have to try to understand these instruments. I would have thought that the cardinal principle is that the instrument should be reasonably clear and written in language that ordinary people would normally use in common speech. I am not sure how many of our statutes really come up to that degree of clarity. Indeed, if one approaches one of the current Bills without any knowledge of its antecedents, the task of trying to find out exactly what it means is quite formidable. To make it more difficult by using rather contrived constructions seems to be contrary to the best use of the statute book.
	I notice that the briefing pack kindly prepared for us by the Library includes drafting guidance for the Office of the Parliamentary Counsel, which says:
	“Some Acts have used ‘they’ or ‘them’ as a third person singular pronoun”.
	It goes on:
	“This use of the plural pronoun is thought by some to be grammatically incorrect, though it reflects common usage and is well-precedented in respectable literature over several centuries”.
	I must say that I was slightly surprised when I read that, but it seems to be fairly authoritative. On the other hand, it does seem that it is not very common usage. Whether it is authoritative and approved by usage may be a matter of interest, but the common situation is that the grammatically correct interpretation would be as the noble and learned Lord, Lord Scott of Foscote, has described it. I should have thought that we want to give as many good examples of good grammar to our fellow citizens and to ourselves as we possibly can.
	I would be very interested to hear from the Minister in due course how this particular practice, which has been decreed by the Leaders of both Houses in directions to parliamentary counsel, contributes to a greater degree of lucidity in our statutes and statutory instruments than would be the case without it.

Lord Quirk: My Lords, in this interesting debate, the noble and learned Lord, Lord Scott, has raised and memorably illustrated a problem which has two sources, one in grammar and the other in political history.
	First, in grammar, like many other languages, English lacks an epicene third person pronoun that can have anaphoric reference to an ungendered antecedent—that is putting it in plain language. For literally hundreds of years, we have vacillated between solutions that partly fit the bill, especially “he”, which is third person and singular but not, of course, epicene, and “they”, which is third person and epicene but not, of course, singular. It is the danger of this “they” creeping into legislation that concerns the noble and learned Lord, Lord Scott, among many others.
	I will illustrate this with an example from the policing Bill that is currently going through this House. In one of the Marshalled Lists, Amendment 56LG reads as follows:
	“The owner of a dog commits an offence if they … are not able to control the dog in a public place”.
	Of course, far more of the amendments employ the traditionally approved solution, using “he”, as in Amendment 58, which says:
	“A person questioned … may not be detained … unless … he is a person falling within section 40(1)(b).”
	In fact, gender neutrality is only one part of the grammatical problem. We lack also the means of expressing number neutrality. After all, when we speak of “anybody” or “everybody”, we are not concerned with specifically singular entities but, well, with everybody. This is another factor tempting us in the direction of “they”. It is not surprising that many of us avoid the singular/plural mismatch by opting for the plural in both antecedent and anaphora, as in, for example, “Persons who live in glass houses are asking for trouble if they throw stones”.
	The second problem issue is political history. When the whole world was solidly male dominated, as large parts of it still are, few people were concerned about the casual assumptions implicit in the generic “he” and kindred expressions such as “mankind” or the Musée de l’Homme in Paris. After all, the word “woman” proclaims that she is merely a subcategory of man, as surely derived from him linguistically as Genesis tells us that Eve was derived from Adam biologically. However, in the past century, when women got jobs outside the home, and then better and better jobs, they started exerting themselves and they increasingly convinced most of us that their grievances included linguistic ones. With striking rapidity, we got used to hearing sentences such as, “Our doctor and her husband were at the meeting”, and we abandoned “policemen” and “firemen” for “police officers” and “firefighters”.
	Of course, languages frequently embody glimpses of the past and past beliefs— even the noble Lord, Lord Rees of Ludlow, might speak of “tomorrow’s sunrise”—so, too, with sexist expressions, including our very own salutation, “My Lords”. If the English, brazen “Every man for himself” sounds particularly blatant, we should not forget that in “Chacun pour soi” “chacun” is not “chacune” and that in “Jeder für sich”, “jeder” is spelled with the masculine “r” and not the feminine “e”.
	In my view, it was perfectly reasonable for Jack Straw in 2007 to call for an end to any such male stereotyping in our use of English, specifically rejecting the Interpretation Act 1978 and its reiteration of the convention that masculine pronouns are deemed to include feminine reference. If it ever worked, that convention no longer does, and there have been convincing psycholinguistic experiments showing that sentences such as “Anyone parking his car here will be prosecuted” predominantly call up images of a man doing the illicit parking.
	To return to the policing Bill, we find that most amendments are thoroughly sensitive in this respect, with anaphoric reference employing “he or she” or repetition—“a person … that person”. But among the
	minority using the traditional “he”, there are striking cases, especially in Amendments 93 to 95, where the singular masculine pronoun is used no fewer than 18 times. In all of them, the antecedent of “he” is surely a tell-tale phrase: “the judge”. Since we do indeed have a judiciary that is largely manned by men, it is hard to believe that the use of “he” in these amendments really means “he or she” rather than endorsing one particular male stereotype as a fact of life.
	At least the amendments show reassuringly little intrusion of the controversial “anyone … they” formulation. Of course, we hear it daily in this House and read it daily in the press, but it has no place in the language of statute, where its comfortably colloquial imprecision is seriously unwelcome.

Lord Kennedy of Southwark: My Lords, I want to place on record my thanks to the noble and learned Lord, Lord Scott of Foscote, for putting down this Question for debate today. Like other noble Lords who have spoken, I am looking forward to the response of the noble Lord, Lord Gardiner of Kimble.
	As the noble and learned Lord, Lord Scott of Foscote, told the House, the drafting of primary legislation has for many years relied on Section 6 of the Interpretation Act 1978, under which words referring to the masculine gender include the feminine. Section 23(1) of the 1978 Act made it clear that Section 6 was applicable not only to Bills and Acts but to statutory instruments.
	That changed on the 8 March 2007, when my right honourable friend Mr Jack Straw, who was then the Leader of the House of Commons, issued a Written Ministerial Statement that was also issued as a Written Ministerial Statement in this House by my noble friend Lady Amos.
	Along with the noble and learned Lord, Lord Scott of Foscote, English is the only language that I understand and speak, which is much to my regret as we are living in a global world where communication is key. Although I fear that I may not be as eloquent in my delivery as many noble Lords in this House, my accent is a mix of south London with Irish influences and a tinge of the east Midlands.
	In preparation for this debate, I asked myself: what is the English language? As noble Lords will be aware, English is a Germanic language and is one of the most widely used languages in the world. It is spoken as the first language by majority populations in the United Kingdom, the United States of America, Canada, Australia, New Zealand, Ireland and a number of Caribbean nations. It is often widely chosen to be learnt as a second language, and is one of the official languages of the European Union and the United Nations. In terms of numbers of people speaking English as a first language, it comes third in the world behind Mandarin Chinese and Spanish. However, when combining native and non-native speakers, it is definitely the second most commonly spoken language in the world, if not the most commonly spoken. It is the required language of communication in seafaring, aviation and many other fields.
	However, the English spoken by the early Germanic settlers from what is today the Netherlands, north-west Germany and Denmark is different and has evolved over the years into the language that we have today. Our language has developed with influences from Old Norse. A number of English words drew their construction from their roots in Latin, as Latin was the lingua franca of the Christian church and European intellectual life.
	The Norman conquest of England in the 11th century gave rise to heavy borrowings from Norman French. All noble Lords will be aware of the use of Norman French in Parliament to signify some of the formalities of Bills passing. Many French words or phrases have crept into the English language, such as mirage, genre, coup d’état and rendezvous. The point is that the English we all speak today is a beautiful language that has a wonderful, rich literature for us all to enjoy, but it has evolved over time. That evolution is a consequence of our development as a nation and as a people, of our history and the influences that have shaped us and our history. It is not a stand-alone, stand-still language. It is growing, evolving, developing and shaping us into who we are today. That is how it should be.
	I very much support the initiative undertaken by my right honourable friend Mr Jack Straw in 2007. I read with real interest the paper by Mr Christopher Williams in the Statute Law Review, “The End of the ‘Masculine Rule’?”. It is clear from the paper that we are not the first Parliament or institution in the world to adopt gender-neutral drafting. We follow in the footsteps of both Australia and New Zealand, which were probably the first English-speaking countries to embrace the principle of gender-neutral drafting.
	Mr Williams’s excellent paper informs us that as far back as 1983, the Parliamentary Counsel’s Office of New South Wales adopted the policy, and on a national level in Australia it was adopted in 1988. Similar reforms happened in New Zealand in 1985. In Canada the policy was adopted in 1991-92, and with the election of President Mandela and the ANC Government, gender-neutral drafting was adopted in South Africa. Looking at international organisations, the United Nations adopted gender-neutral drafting during the latter half of the 1980s. The International Labour Organisation began drafting its conventions in a gender-neutral way at around the same time. The European Union began the switch in 1998, though you can find examples there where the masculine rule still applies.
	My noble friend Lady Corston, when she was the Member for Bristol East in the other place, raised the issue in the Commons on 7 May 1995. It was reported in the Guardian on 9 March 2007 that my friend in the other place, Meg Munn MP, said:
	“It may seem a small thing in one sense, but language is important. We have a society in which we believe men and women are equal, so why shouldn’t the law refer to us equally? Many other English-speaking countries do so already”.
	I very much agree with the comments of my friend in the other place. You could say that we have not been quick off the starting blocks here. We took more of a long-term view, but correctly made the change in 2007.
	I very much hope that the noble Lord, Lord Gardiner of Kimble, will tell the House when he responds to the debate that, moving forward, the changes announced by Mr Jack Straw are here to stay. In saying that, I accept fully that we are not going to go back and start rewriting laws just to change the language, but that, in a sensible and proportionate way as we move forward, gender-neutral drafting will become the norm. I also accept fully that we have to ensure that the legislation we pass does what it says on the tin and that there must not be any inconsistencies. We should work to achieve the maximum clarity in the laws we pass in Parliament.
	As I see it, when we have a Bill making a minor change or textual amendment to an existing Act, it would not be sensible to go through and make a whole load of gender-neutral changes to the original Act. But, where you introduce a whole new Bill to put substantial new laws onto the statue book, you should seek to make sure that it is gender-neutral. I do not agree with the point made by the noble and learned Lord, Lord Scott, about the matter of principle, but I agree with him that the legislation we pass has to be clear. He highlighted skilfully to the House some of the issues and problems that we have with the drafting of statutory instruments. I am sure that the Minister will look seriously at them, because they have serious implications for the Government, when he takes this away afterwards.
	I am also of the opinion that our language evolves with us and reflects on us. As it illustrates who we are, it must make sense and not be difficult to understand. Nowhere is that more important than in the laws we pass. Again, I thank the noble and learned Lord, Lord Scott, for his interesting debate today. I thank all noble Lords who spoke and look forward to the response of the noble Lord, Lord Gardiner of Kimble.

Lord Gardiner of Kimble: My Lords, I congratulate the noble and learned Lord, Lord Scott of Foscote, on securing this debate, which has been informative and illuminating. It is somewhat daunting to reply to two noble and learned Lords and to the noble Lord, Lord Quirk, who is an expert in language and linguistics of some considerable renown. We were also reminded by the noble Lord, Lord Kennedy of Southwark, of the evolution of our language. All this has helped to inform this debate. While I know that some have reservations about the style of the legislation which has resulted from the use of gender-neutral language, I am sure that your Lordships will agree that the motives for making the transition were sound.
	For many years parliamentary counsel, who draft legislation, relied on Section 6 of the Interpretation Act 1978, to which my noble and learned friend Lord Mackay of Clashfern and the noble and learned Lord, Lord Scott of Foscote, referred. That provision says that words referring to the masculine gender include the feminine, and vice versa. In practice, this means that male pronouns such as “he” were used in contexts where a reference to women and men was intended. This indeed aided brevity, but many people believed
	that the practice tended to reinforce historical gender stereotypes. The noble Lord, Lord Quirk, gave your Lordships some good examples of that.
	The policy of gender-neutral language in legislation was announced by the previous Government in a Written Statement on 8 March 2007, as the noble Lord, Lord Kennedy of Southwark, said. Parliamentary counsel were asked to use,
	“gender-neutral drafting so far as it is practicable, at no more than a reasonable cost to brevity or intelligibility”.—[ Official Report , Commons, 8/3/07; col. 146WS.]
	However, I reassure the noble and learned Lord, Lord Scott, that we are not abandoning the Interpretation Act. The 1978 Act is still needed for amendments to old legislation that predates the move to gender-neutral drafting. The noble Lord, Lord Kennedy of Southwark, referred to that. Parliamentary counsel sometimes still use gender-specific pronouns when amending old legislation to ensure that it remains coherent. The 1978 Act enables masculine or feminine words to be used in legislation to cover both genders but does not contain drafting guidance about how to draft.
	Even before the move to gender-neutral drafting in 2007, there was no requirement to use gender-specific pronouns. There are plenty of examples of old provisions that were drafted in gender-neutral terms and without reliance on the 1978 Act. Interestingly, the 1978 Act was a consolidation and may be traced back to legislation first enacted in 1850. I know that the noble and learned Lord, Lord Scott of Foscote, referred to the 1978 Act as not being ancient, but 1850, while it may not be very ancient, is quite a long time ago.
	The move to gender-neutral drafting brought us in line with other jurisdictions which use the English language, where it had been the norm for many years: Ireland, New Zealand, Canada, parts of Australia and the United States of America, as well as the three devolved legislatures. The noble Lord, Lord Kennedy of Southwark, included South Africa in that list. With the change to gender-neutral drafting, a range of drafting styles was developed: for example, omitting the pronoun, repeating the noun, replacing the noun with a letter such as the letter P, using defined terms or using “he” or “she”, and so on. Parliamentary counsel have tried to simplify drafting so that it is not ambiguous or too lengthy.
	In places, the move caused drafters to reword propositions so that they indeed became shorter and clearer. For example, “the Secretary of State may, if he thinks fit” could become simply, “the Secretary of State may”. Before the change, the drafting may have said, “A person commits an offence if he drops litter in a public place”, but now it could be simplified to, “A person who drops litter in a public place commits an offence”. However, we recognise that there are some techniques that people find easier to follow than others, and I have much sympathy with people who do not like techniques such as the use of letters—“P” and so on—to identify different people.
	I hope that your Lordships will be pleased to note that the Office of the Parliamentary Counsel has agreed to revise its drafting guidance to recommend that the approach of using letters to identify people is used sparingly, although it may sometimes be a useful
	way to distinguish between several people. It will also be considering whether any other adjustments could usefully be made in light of the helpful feedback from this debate.
	Etymologists may disagree but the guidance from parliamentary counsel provides that some terms are to be treated as gender-neutral. These include “testator”, “manager” and “actor”, although they have female equivalents. There are also some terms that have always been gender-neutral—for example, Secretary of State and Prime Minister.
	Gender-specific pronouns are still sometimes used in legislation that amends older legislation, as it is important for the amended Act to remain coherent. For example, if there is a list of conditions each of which begins with “he”, it would be confusing to start a new condition starting with “the person”.
	The guidance also recognises that there must be some flexibility and that there will be some Acts where only gender-specific drafting can be usefully applied. In a case where a person has to be of a particular gender—male or female—gender-neutral drafting does not require drafters to avoid referring to the gender. I think your Lordships would agree that that would be the case for legislation about maternity.
	I turn to the specific points raised by the noble and learned Lord, Lord Scott of Foscote, in his detailed account of various provisions in subordinate legislation. I hope that he will forgive me if I do not engage in what I would call the intricacies of what he has quite rightly outlined, but I reassure noble Lords that the Government remain committed to producing high-quality legislation that is clear, accessible and free from ambiguity. We believe that gender-neutral drafting is perfectly compatible with that objective. It ensures that our law is expressed in a way that clearly covers all citizens without requiring people to consult Section 6 of the Interpretation Act 1978.
	Most of the examples that were mentioned concern the use of “they” as the third person singular pronoun. Although some regard this usage as grammatically incorrect, it reflects common usage, as my noble and learned friend Lord Mackay of Clashfern said with regard to the brief from the Library, and is well precedented in literature over the centuries. However, the noble Lord, Lord Quirk, referred to the risks of using the word “they” in the singular form. This is noted in the parliamentary counsel’s drafting guidance, and care obviously needs to be taken when drafting any legislation to ensure that it is not ambiguous.
	I turn to the Good Law initiative, which the First Parliamentary Counsel is spearheading. This initiative, about which I have spoken before in your Lordships’ House, aims to improve drafting, reduce complexity and make the law more accessible, and I believe that these are the objectives that we all seek. The parliamentary counsel’s initial report aspires to good law, which is defined as necessary, effective, clear, accessible, coherent and, if I am allowed, I would like to add my noble and learned friend Lord Mackay’s word “lucid”. This is a sentiment that I very much hope we share across all sides of the House. With that in mind, the Government acknowledge that the use of gender-neutral drafting must result in legislation that is effective, clear and accessible.
	I thank all noble Lords who have spoken today. I will be taking away what has been said. I know that officials, particularly Good Law initiative officials, will be looking strongly at the points that have been made. The Government take extremely seriously the importance of ensuring that legislation is more accessible and less complex. As I say, I will ensure that full consideration is given to everything that your Lordships have spoken about today.

Lord Scott of Foscote: My Lords, I offer my thanks to the Minister for his very complete answer and my gratitude to everyone who has taken part in this debate.

House adjourned at 6.30 pm.